#interesting cases

A couple of fun (not so fun) cases that I’ve had recently;

1. This cell was found within the peripheral blood smear of a dog with multicentric lymphoma affecting several lymph nodes. Unfortunately, this is a medium to large lymphocyte with a prominent, abnormally shaped nucleolus in the nucleus (lymphocytes do not usually have visible nucleoli!) which insinuates the lymphoma has reached Stage V, and has entered circulation or the bone marrow.

“Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model of health and disability, a model which conflates amputation with impairment, and impairment with a disability.”

“Opponents argue that to amputate a medically healthy leg inflicts serious disproportionate harms upon that individual, not only through the amputation process itself and its associated risks but also by inflicting disability onto a previously non-disabled individual. According to this argument, using therapeutic healthy-limb amputation as a means for treating BIID breaches the principle of nonmaleficence as it invariably causes significant harms to the individual as it makes them irreversibly disabled. In response, those who tentatively support the procedure in cases of BIID argue that the harms, including the generation of disability, are potentially outweighed by the benefits, such as a significant decrease in suffering and the minimization of potential future risks”

You’re lucky I keep a file of interesting stuff. Here goes (I definitely have posts in the archive about some of these things):

Genetic: Marfan Syndrome, Type 1 Ehler’s Danlos, Mayer-Rokitansky-Kuster-Hauser (Müllerian agenesis) syndrome, Treacher-Collins Syndrome, Turner Syndrome, Osteogenesis Imperfecta, Rett Syndrome, Huntington’s disease, Apert Syndrome, Neurofibromatosis, Tuberous Sclerosis, Cornelia de Lange Syndrome

Neuro: Too much ALS, Progressive Supranuclear Palsy, Chronic Immune Demyelinating Polyneuropathy, a bilateral occipital stroke causing complete blindness (pretty rare), Guillain-Barré syndrome, Lennox-Gastaut Syndrome, Wernicke-Korsakoff Syndrome, Reflex Sympathetic Dystrophy as a late sequella of venomous snakebite

Heme-Onc: Bilateral Wilms Tumors, an intra-aorta tumor, Retinal Metastases of Breast cancer, Carcinoid Syndrome, Paraneoplastic Parkinson’s from Small cell lung cancer, hemophilia, systemic mastocytosis, Kaposi’s Sarcoma, Sézary Syndrome, Cutaneous B cell Lymphoma

Infectious (remember that I’ve done a good bit of tropical medicine):  Tertiary Syphillis + HSV Encephalitis in an AIDS patient, tons of Cerebral Malaria (and regular malaria) and typhoid, Elephantiasis, Onchocerciasis, Fournier’s Gangrene, Pericarditis, Endocarditis, Rheumatic Fever, Brucellosis, Sporotrichosis, Histoplasmosis, Pasturella Multocida infection of a tendon, MAC, disseminated MAC, lots of Pulmonary TB/Scrofula/Pott’s Disease, Congenital Rubella, Congenital Syphillis, lots of Zika and Chikungunya, Necrotizing Fasciitis, Empyemas, Giardia, Campylobacter infections, cutaneous leishmaniasis, Buruli ulcer, a possible case of Monkeypox (though we couldn’t test this...definitely a poxvirus tho), lots of intestinal worms, pulmonary nocardiosis, joint infection with Leuconostoc

Endocrine: Thyroid storm, Myxedema Coma, Addisonian Crisis, Cushing’s Disease, Pheochromocytoma, MEN Syndrome, Precocious puberty in a 5 year old

Nephro: Bartter and Gitelman Syndromes, Malaria-induced Nephrotic syndrome, Synthetic marijuana-induced end stage renal failure requiring dialysis

Toxic: Serotonin Syndrome, Neuroleptic Malignant Syndrome, tons of venomous snakebites including a few causing consumption coagulopathy and death, Carbon monoxide poisoning, Organophosphate poisoning, Formaldehyde poisoning from homemade vape juice gone wrong, lots of pica (although it’s sort of a cultural thing to eat clay)

Psych: Fixed Erotomanic Delusion, Cotard’s Delusion, Conversion Disorder, Depressive Pseudodementia, Menopausal psychosis, post-partum psychosis

Cardiac: Long QT Syndrome (congenital and acquired), HOCM, Takotsubo Cardiomyopathy, Prinzmetal angina secondary to diet pills, isolated dextrocardia, Tetralogy of Fallot - corrected and once uncorrected in an adolescent! Hypoplastic Left Heart, WPW, Dextrocardia + transposition of the great vessels. 

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