CASE STUDY # 1:
ID/CC A 1 year old white girl is brought to the emergency room because of sudden weakness, apathy, easy bruisability, and periorbital edema with low urinary volumes
HPI The infant experienced diarrhea and had vomited for two days, but her condition resolved spontaneously four days before her admission
PE Pallor; listlessness; hepatomegaly; periorbital and ankle edema; purpuric rash on chest and limbs
Labs CBC/PBS: low RBC’s & Hb; low platelet count; UA: proteinuria, hematuria; RBC casts.
What is the Diagnosis?
CASE STUDY # 2:
ID/CC A 25 year old white female continues to bleed steadily after a normal, spontaneous vaginal delivery.
HPI Manual exploration of the uterus reveals retained placental tissue that requires dilatation and curettage; 30 minutes after the procedure, the patient begins to bleed diffusely from her gums and continues to bleed vaginally.
PE Diffuse bleeding in gums and oral mucosa; bleeding diathesis seen in skin (both petechiae and purpura) with oozing from venipuncture sites.
Labs CBC: low platelet count.
What is the Diagnosis?
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CASE STUDY # 3:
ID/CC A 3 year old white female is brought to the emergency room with a skin rash and severe epistaxis.
HPI The patient had an upper respiratory tract infection consisting of a severe cough and runny nose five days before the onset of her symptoms.
PE Mucosal petechiae; epistaxis; hemorrhagic bullae in buccal mucosa
Labs CBC: mild anemia; platelet count (10,000/μL); RBC and WBC counts normal. Mildly prolonged bleeding time, PTT and PT .
What is the Diagnosis?
CASE STUDY # 4:
ID/CC A 68 year old white male visits his doctor complaining of weight loss, increasing fatigue, weakness, headache, and visual disturbances over the past several months.
HPI He also complains of easy bruising and bleeding gums while brushing his teeth.
PE Generalized lymphadenopathy; moderate hepatosplenomegaly.
Labs CBC/PBS: anemia (Hb 7.3); RBC rouleau formation; increased serum viscosity
Imaging XR-plain: absence of lytic lesions so don’t say Multiple Myeloma
What is the Diagnosis?
CASE STUDY # 5:
ID/CC A 62 year old Jewish male visits his family doctor because of epistaxis.
HPI The patient had black, tarry stools two months ago and was previously admitted to the hospital for deep venous thrombosis. He also describes episodes of severe generalized itching, primarily after showering
PE VS: hypertension (BP 170/100). PE: patient obese and plethoric; mild cyanosis; engorged, palpable spleen
Labs Normal PO2, PCO2, and PT; increased vitamin B12 levels, increased serum and urinary uric acid levels.
What is the Diagnosis?
Solution:
CASE STUDY # 1:
ID/CC A 1 year old white girl is brought to the emergency room because of sudden weakness, apathy, easy bruisability, and periorbital edema with low urinary volumes
HPI The infant experienced diarrhea and had vomited for two days, but her condition resolved spontaneously four days before her admission
PE Pallor; listlessness; hepatomegaly; periorbital and ankle edema; purpuric rash on chest and limbs
Labs CBC/PBS: low RBC’s & Hb; low platelet count; UA: proteinuria, hematuria; RBC casts.
What is the Diagnosis?
ANSWER
Hemolytic Uremic Syndrome
Classic triad of Hemolytic anemia, Thrombocytopenia and Acute Renal Failure (ARF).
Seen in infants and young children and is clinically similar to Thrombotic Thrombocytopenic Purpura (TTP) except for milder neurologic abnormalities (the sudden weakness, apathy) and more severe renal disease (periorbital edema from proteinuria)often progressing into acute renal failure
The association here is with toxin produced by E. coli, serotype 0157:H7, commonly occurring in raw hamburger meat.
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