1/3. A case of common variable immunodeficiency presenting with furunculosis.common variable immunodeficiency (CVID) is the most prevalent of the primary immunodeficiencies, and is characterised by low IgG and IgA, and sometimes IgM. There is some evidence of genetic susceptibility, with 20% of patients having a dominantly inherited disorder with variable expression. It is a heterogeneous disorder with protean manifestations, and as a result diagnosis is often delayed until the second or third decade, with resultant irreversible organ damage, in particular bronchiectasis. Effective treatment is available with regular 3-4-weekly infusions of immunoglobulin. The mechanism of the immunodeficiency has not yet been fully elucidated. The majority of patients present with recurrent sinopulmonary infection, however, this is a multisystem disorder and thus presents to physicians in diverse specialties including dermatology. Other clinical features of the disorder include gastrointestinal problems, granulomatous inflammation, cutaneous features, unusual presentations of enteroviral and mycoplasma infection, an increased incidence of autoimmunity, and a predisposition to lymphoma and stomach cancer. Therefore a knowledge of the disorder and appropriate suspicion by all clinicians of the possibility of such rare problems and a consequent low threshold for performing relevant investigations is imperative in allowing early recognition and instituting effective treatment. We describe a case of CVID identified when the patient developed widespread skin infection, fever and malaise. This case is an important example of a possible presentation of CVID within the dermatology clinic and demonstrates that maintaining a high level of clinical suspicion is essential for the diagnosis of the rare primary immunodeficiencies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Transmission of Panton-Valentine leukocidin-producing staphylococcus aureus to a physician during resuscitation of a child.We report the first case of transmission of Panton-Valentine leukocidin-producing staphylococcus aureus to a physician during the resuscitation of an infant with fatal pneumonia. The physician exhibited numerous furuncles. This case highlights the necessity for health care workers to protect themselves against transmission of infectious diseases from patient to care giver.- - - - - - - - - - ranking = 6keywords = physician (Clic here for more details about this article) |
3/3. An unexpected surprise in a common boil.Cutaneous myiasis (myia: Greek word for fly) is an infestation of fly maggots in the skin. A case of human botfly (Dermatobia hominis) myiasis presenting to a Canadian emergency department is described. Typically, it presents as an apparent persistently infected skin abscess or insect bite. As the botfly is indigenous only to Central and south america, the condition is unfamiliar to most North American physicians. However, the rapidity of international air travel permits this exotic tropical infestation to present in any region. Obtaining a history of recent travel to an endemic area is the key to making the diagnosis and instituting appropriate treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |