A 25-year-old Haitian man with chills, fever, abdominal pain, and renal failure

Article Abstract:

A previously healthy, 25-year-old black man, a native of Haiti who had been a resident of the US for four years was admitted to the hospital with fever, chills, night sweats, and abdominal pain which first appeared 24 days before his admission. Two months prior to admission he had taken a trip to Haiti for one month. He did not use tobacco, drugs or alcohol, and stated that he had had no homosexual or heterosexual activity. Upon admission, the patient had a continuous dull headache, severe fatigue, a dry cough and loss of appetite and he was moody and uncooperative. An extensive series of tests was conducted including blood, urine, and spinal fluid analysis. X-rays (including CT scan) were taken and the patient was monitored closely. Tests and examination revealed that the lungs were clear, the heart and abdomen were normal, but kidney function was abnormal. Hepatitis and HIV antibody tests were negative. A differential diagnosis, a diagnosis based on comparison of symptoms of two or more similar diseases, was made. The most critical symptoms in making this diagnosis were his fever, abnormally high concentrations of monocytes (a type of white blood cell) in the blood, anemia and dehydration. The diagnosis was acute falciparum malaria, accompanied by severe kidney failure as well as a strong suspicion of cerebral malaria. Acute falciparum malaria is a type of malaria caused by the parasite Plasmodium falciparum, prevalent in the tropics. Typically, symptoms of this type of malaria are more severe than other varieties, but the infection usually runs a shorter course without relapses. Cerebral malaria results from a tendency of the parasites to clump together in the brain which may lead to coma or sudden death. A positive Wright-stained blood smear, a test which reveals the presence of malarial parasites, supported the diagnosis of malaria. Gradual improvement was observed in the kidneys and after 10 days the patient was well enough to be discharged; he showed additional improvement upon follow-up examination. The possibility of AIDS was not completely ruled out. The patient, unfortunately, continued to exhibit paranoid psychosis, of which he had a history.

Research, Brain, Malaria, Plasmodium falciparum, Acute renal failure, Acute kidney failure, Colvin, Robert B., Diamond, Jonathan R.

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A 21-year-old man with recurrent left-sided pneumonia

Article Abstract:

A case is described of a 21-year-old man suffering from repeated bouts of pneumonia affecting the left lung only. The first episode of pneumonia took place three years before the current episode, which was his fifth recurrence. The young man's symptoms included shortness of breath, a productive cough, fever and wheezing. He had never required hospitalization in the past, but in the latest episode this became necessary as his symptoms were worse and included dizziness, vomiting and a severe headache. The evaluation involved chest X-rays, blood and urine tests and an extensive medical history. The patient had no history of exposure to tuberculosis or sexually transmitted diseases, including AIDS, the acquired immunodeficiency syndrome. He worked as a cook on a cruise boat that traveled only along the coast of New England, and lived with his parents. The patient smoked one pack of cigarettes a day and had been a heavy drinker in the past. Some of the possible causes of his recurrent pneumonia that were considered were congenital abnormalities of the respiratory tract, cystic fibrosis, infectious diseases, and aspiration of a foreign body. While tumors of the lung are rare in young patients, this possibility was also evaluated. Examination by CT (computed tomography) scan showed a tumor, and a biopsy was taken. The final diagnosis was a cancerous tumor of the bronchus, which was removed surgically. One year later, the patient was in good health. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pneumonia, Lung cancer

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