The patient was a 20 year old medical student who presented to his GP with right sided abdominal pain. During a lecture and practical session on liver disease his friend had performed a textbook abdominal examination on him and reported his liver was a bit enlarged. The patient now was worried he might have liver cancer! The GP rolled his eyes, hadn’t anyone explained to these students that they could only have 3 fatal diseases a year without becoming paranoid? Take it from me, medical students tend to associate every symptom they have with the most severe disease they can imagine or the one they are currently learning about… it’s a normal and common ailment which does subside with experience and without treatment :-)
The patient’s mother was at her wits end. Her little boy’s head was covered in scaly skin. At first she thought his scaly hair was dandruff so she had washed his hair in medicated shampoo but this was met with screams and tears. She thought he was being a bit extreme “it’s only dandruff” but guessed kids can be funny about having soap in their eyes. He just kept saying “mummy my head is really sore”. Tonight he had refused to have his hair washed and while trying to get him into bed, she noticed he was going bald! She was so alarmed that she brought him in to the Emergency Department for help.
The Microbiologist groaned as his pager went off at midnight, waking him after he had just dozed off. He stumbled over the sleeping cat and went to answer the call, while his wife stirred and uttered something unrepeatable. However, rather than one of the normal “you should know this from medical school” types of call the Microbiologist soon snapped awake as the story unfolded.
The patient had returned 5 days ago from visiting family in Israel. They had a fever and muscle pains but had come in to hospital as they had noticed a florid rash all over their body when getting undressed to go to bed. The A&E doctor was concerned this might be meningococcal sepsis but as the patient was an adult they thought they better get advice about what to do.
“We want to know whether to stop the Aciclovir”, said the Doctor.
The Microbiologist took a deep breath. This was a surprisingly regular but unhelpful opening gambit from those calling for advice, “would you perhaps like to tell me about the patient?” he asked.
“Oh yeah, sorry! He’s 53 years old; previously fit and well. He returned from trekking in Nepal nearly two weeks ago. He was well whilst on holiday but became unwell four days ago with a flu-like illness which progressed to nausea and vomiting followed by headache, confusion and difficulty speaking. We thought this was encephalitis but his CSF HSV PCR is negative so we wondered whether it is alright to stop the Aciclovir” asked the doctor.
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