6411:MODULE # 7: CASE STUDIES DIABETES AND THE ENDOCRINE DISEASES

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  • MODULE # 7: CASE STUDIES
    DIABETES AND THE ENDOCRINE DISEASES
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    Case Study # 1:

    Case Study # 1:

    A 61-year-old man presents to the emergency department (ED) complaining of pain in his right eye with associated redness and swelling for the past 5 days. The patient had been examined at another ED a few days ago and was discharged home with a diagnosis of herpes zoster and a prescription for acyclovir and hydrocodone.
    Since he started taking the acyclovir, the patient noticed that the pain and swelling in his eye increased. He also reports binocular diplopia and decreased visual acuity. Today, he is nauseous and vomiting, and he cannot open his eye.
    On physical examination, the patient has normal and stable vital signs. Visual acuity in the unaffected left eye is normal at 20/25. In the affected right eye, he can perceive only bright light. In addition, the affected eye has ptosis of the upper eyelid, generalized proptosis, and mild periorbital erythema with associated edema (see Image). The right pupil is 8 mm in diameter and nonreactive to direct and indirect light. Intraocular pressure in both eyes, as measured by using a handheld measurement device (TonoPen), is normal at 12 mm Hg.
    1.  What is the diagnosis? do not be fooled by the alert look of the man
    Hint – The patient has diabetes mellitus and has been unable to control his blood glucose levels over the past 2 weeks.
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    Case Study # 2:

    Case Study # 2:

    CC An obese 44 year old female complains of irritability and excessive weight gain (40 kg) over the past three years and requests medical weight-loss therapy.On careful questioning, she also reports easy bruising, oligomenorrhea, weakness, and increased hair growth in various areas of her body over the same period.
    PE VS: hypertension (BP 180/100).
    Labs UA: 3+ glucosuria. Elevated fasting blood sugar (141); hypokalemia. CBC: leukopenia.
    1.  What is the Diagnosis?
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    Case Study # 3:

    Case Study # 3:

    CC A 42 year old female is discovered to have hypertension on a routine physical exam.
    HPI She had been suffering from headaches, weakness, and leg cramps. She has been not sleeping well often waking up to go the bathroom.
    PE VS: hypertension (BP 165/110). PE: diminished deep tendon reflexes; examination otherwise unremarkable.
    Labs Na+ = 154 mEq/L (N = 136-145 mEq/L); K+ = 2.4 mEq/L (N = 3.6-5.2 mEq/L) ECG: flattened T waves, long Q-T, U waves.
    1.  What is the Diagnosis?
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    Case Study # 4:

    Case Study # 4:

    CC A 29 year old female is brought into the emergency room following a seizure on her way to work.
    HPI The patient underwent thyroid surgery for papillary cancer two years ago. Soon after she has been fatigued and weak; this caused her to miss many work days. Her coworkers described that she complained from “muscle twitches” in her hand and that she hasn’t been herself since the surgery – more irritable and sad.
    PE Blood pressure 130/85
    1.  What is the Diagnosis?
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    Case Study # 5:

    Case Study # 5:

    CC A 56 year old white female complains of severe, colicky left flank pain radiating to the groin and inner thigh and associated with nausea, vomiting, and bloody urine.
    HPI She has a history of burning epigastric pain that is relieved by food. Her history also reveals anorexia, confusion, irritability, constipation, easy fatigability, excessive thirst, and polyuria.
    PE Cornea (see pic); right flank tenderness; thick fingernails; decreased muscle tone.
    Labs UA: hematuria. Elevated urine calcium and phosphorus.
    X-Ray (see pic) note the “salt and pepper” appearance.
    1.  What is the Diagnosis?
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    Case Study # 6:

    Case Study # 6:

    CC A 23 year old female is brought into the emergency room unconscious following a seizure in college
    HPI Her classmates state that she was extremely week this morning and she mentioned that she has severe headache, dizziness, blurring of vision, and that she vomited few times before class. But she had to attend to take the midterm test. She has a history of Crohn’s disease for which she was receiving treatment.
    PE Blood pressure 72/45; Resp: 32/min; pulse: 120beats/min-irregular
    Labs Serum glucose: 50 mg/dL; K+ 6.6 mEq/L; Na+ 123 mEq/L; pH = 7.1
    After administration of dextrose, thiamine, levophed and dopamine her BP is now 80/52 only.
    1.  What is the next drug to be administered?
    2.  What is the most likely diagnosis?

Solution:

CASE STUDY # 1:

A 61-year-old man presents to the emergency department (ED) complaining of pain in his right eye with associated redness and swelling for the past 5 days. The patient had been examined at another ED a few days ago and was discharged home with a diagnosis of herpes zoster and a prescription for acyclovir and hydrocodone.

Since he started taking the acyclovir, the patient noticed that the pain and swelling in his eye increased. He also reports binocular diplopia and decreased visual acuity. Today, he is nauseous and vomiting, and he cannot open his eye.

On physical examination, the patient has normal and stable vital signs. Visual acuity in the unaffected left eye is normal at 20/25. In the affected right eye, he can perceive only bright light. In addition, the affected eye has ptosis of the upper eyelid, generalized proptosis, and mild periorbital erythema with associated edema (see Image). The right pupil is 8 mm in diameter and nonreactive to direct and indirect light. Intraocular pressure in both eyes, as measured by using a handheld measurement device (TonoPen), is normal at 12 mm Hg.

What is the diagnosis? do not be fooled by the alert looks of the man

Hint – The patient has diabetes mellitus and has been unable to control his blood glucose levels over the past 2 weeks.

ANSWER

Rhinocerebral Zygomycosis

One should not be fooled by the “alert” looks of the man; in few hours he will get into coma and death ensues quite fast. Mucormycosis is common with acidosis from DM.

Mucormycosis is a very interesting subject, it is also very acute & complications include “post-mortum diagnosis”….not good!

If you think Immunocompromised & infection, rule out Mucormycosis, it goes misdiagnosed often.

The organism does not affect the immunocompetent because of inhibitory effects of the host on the spores (prevents their germination)…… To purchae the solution, click below