Inflammation Case Presentation

Case # 1

History A 20-year-old woman with only a one day history of : lower abdominal pain, nausea with anorexia and fever. Physical examination, there was Periumbilical pain. over the next couple of hours, the pain migrated to the right lower quadrant. Her vital signs showed T 38.5 C, P 90, R 18, and BP 110/70 mm Hg.

Question: What is the differential diagnosis? Answer: Acute appendicitis Acute salpingitis Ruptured ovarian cyst Ruptured ectopic pregnancy Acute UTI Acute enteritis

Question: what are the most important laboratory tests that would be helpful for the diagnosis? Answer: WBC count was 11,500 with 76% polys, 6% bands, 14% lymphs, and 4% monos. A pregnancy test was negative. Urinalysis was normal.

Question: What diagnosis do you suspect? Answer: Acute appendicitis.

Question: What is the treatment Answer: There is no medical therapy for acute appendicitis. Surgery, the patient should have an appendectomy .

The gross appearance of the appendix removed at surgery.

Question: What is seen prominently in the tissue section?

The low power microscopic appearance. The mucosa is focally eroded The low power microscopic appearance. The mucosa is focally eroded. There is acute inflammation with many neutrophils. The inflammation extends through the wall and appears on the serosa.

The high power microscopic appearance of the appendix The high power microscopic appearance of the appendix. There is acute inflammation with many neutrophils.

Question: What could happen if this is not promptly treated? Answer: The wall of the appendix could rupture, producing an acute peritonitis and/or abscess. The patient could become septic and die Rupture is more likely to occur in the very young and old, when the diagnosis is not suspected and/or is delayed.

Case # 2

- Cervical lympadenopathy, decreased breath sounds . History A 4-year-old child with three weeks history of: - Cough, loss of appetite, night sweat and persistent fever. Physical examination, there was: - Cervical lympadenopathy, decreased breath sounds . Vital signs showed T 38.7 C, P 120, R 28, and low BP.

Question: what are the most important tests that would be helpful for the diagnosis? Answer: WBC count was 11,500 with 49% polys, 6% bands, 47% lymphs, and 4% monos. Chest X-Ray, revealed right sided pleural effusions and ill defined consolidation on the right middle lobe with hilar lymphadenopathy.

Chest X-ray

Question: What diagnosis do you suspect? Answer:  - Bacterial pneumonia.

Rx: - Antibiotics and antipyretic drugs. Follow up: The child does not improve with standard antibacterial therapy. Think of atypical bacterial infection?? think of TB?

Question: what further tests you may order to help you in diagnosis? Tuberculin Skin Test ( PPD test). TB PCR. AFB staining on pleural fluid, lung tissue, lymph node tissue. Histological examination of: Lung or pleural tissue.

 Ziehl–Neelsen stain