Dr House has a new case for Attending rounds

[FootDocStudent]

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I have a 13 year old Caucasian female with albino eyes and painful abdominal pain with bloody diarrhea. She is hypotensive due to intense hemorhaging. She is lethargic and very weak with altered mental status. She has no PMH and no meds and NKDA. Her family history includes HTN, type 1 DM, CHF, breast cancer, and Crohn's Disease. What is on top of my differential diagnosis?

 

[347932]

Ulcerative Collitis.

 

[jonwill]

Did she happen to eat at Taco Bell prior to the incident?

 

[podpal]

Chron's

 

[FootDocStudent]

Ulcerative Collitis.

Interesting! But no, try again.

 

[FootDocStudent]

Chron's

No but try again

 

[FootDocStudent]

Did she happen to eat at Taco Bell prior to the incident?

No but that is good thinking! Ask more about the history.

 

[karntrev]

What about Jack-in-the Box? E. coli O157:H7.


Celiac Disease?

 

[krabmas]

hermansky pudlak syndrome = albinism with hemorrhagic diathesis

 

[janV88]

When did the abdominal pain start?
Where in the abdomen is the pain exactly? (point to it)
Does it radiate?
Pain from 1-10? What would you consider a 10? (example)
Is it painful now?
On and off?
What makes it worse/better?
When did the bloody diarrhea start?
On and off?
What makes it worse/better?
Has this happened before?
Any history of parents or siblings with similar complaints?
What do you think it could be?

 

[347932]

hermansky pudlak syndrome = albinism with hemorrhagic diathesis

This.

 

[krabmas]

This.

I actually saw a case during residency. On my medicine rotation the other intern on my team admited a peurto rican pt (more common in PR) with HP albinism. She was admitted for her restrictive/fibrotic lung disease. She was in her 30s and these pt unfortunately only live into the 40-50s due to the fibrotic lung disease. Their other organs may also become fibrotic.

 

[FootDocStudent]

This.

Dr House says: Krabmas and Kidsfeet are correct. Hermansky Pudlack Syndrome. The hint was albino eyes plus diarhea plus abdominal pain plus bleeding. Nice work. 😀

 

[FootDocStudent]

When did the abdominal pain start?
Where in the abdomen is the pain exactly? (point to it)
Does it radiate?
Pain from 1-10? What would you consider a 10? (example)
Is it painful now?
On and off?
What makes it worse/better?
When did the bloody diarrhea start?
On and off?
What makes it worse/better?
Has this happened before?
Any history of parents or siblings with similar complaints?
What do you think it could be?

Dr House says: janV88 is automatically my Intern (PGY-1). This line of questioning is a sign of an excellent doctor. Be nosy and think out of the box. Ask ask ask. 🙂

 

[FootDocStudent]

What about Jack-in-the Box? E. coli O157:H7.


Celiac Disease?

Dr House says: No none of these. But lower priority in the differential. 😉

 

[FootDocStudent]

This.

Dr House says: Yes. Correct! 😀 Fine work! Other podiatry students and podiatrists, read up on this rare genetic disease please! Kidsfeet already did I see. Harrison's or Cecils are good, so is Merck's Manual.

 

[347932]

Dr House says: Krabmas and Kidsfeet are correct. Hermansky Pudlack Syndrome. The hint was albino eyes plus diarhea plus abdominal pain plus bleeding. Nice work. 😀

I take no credit. It was all Krabmas.

 

[FootDocStudent]

I take no credit. It was all Krabmas.

Dr House says: Nice work with this case. But all of you podiatry people did not diagnose my previous case yet. It is still open. The patient is still alive, not yet in the post mortem lab and no M&M by Princeton Plainboro Hospital. Back track to around September. Dr Cuddy is getting on my case.... I am WAITING for a diagnosis, people. 😴

 

[FootDocStudent]

Dr House says: This is the case still open since September 5th! Please get Dr Cuddy off my case (she is my secret lover you know) and avoid an M&M investigation by Princeton Plainsboro!

Dr House says: I have a 4 year old Japanese American female with bilateral bulging eyes, suffering from thirst despite hydration, with red crusty sores on her trunk, scalp, dorsum of the hands and feet, deafness, trouble walking normally, weakness and tingling in the feet and ankles, and swollen lymph nodes in the neck and thighs and trunk for the past 1 year. She has a past medical history of hypopituitarism. Her family history consists of sarcoidosis, tuberculosis, and leukemia. Her medications are levothyroxine and hydrocortisone. She is allergic to penicillin with skin rash and pruritis. Her temp is 100 F and CBC with diff. shows anemia and neutropenia. I am suspicious of one disease. What disease is ON TOP of my differential? 😕

 

[krabmas]

Dr House says: This is the case still open since September 5th! Please get Dr Cuddy off my case (she is my secret lover you know) and avoid an M&M investigation by Princeton Plainsboro!

Dr House says: I have a 4 year old Japanese American female with bilateral bulging eyes, suffering from thirst despite hydration, with red crusty sores on her trunk, scalp, dorsum of the hands and feet, deafness, trouble walking normally, weakness and tingling in the feet and ankles, and swollen lymph nodes in the neck and thighs and trunk for the past 1 year. She has a past medical history of hypopituitarism. Her family history consists of sarcoidosis, tuberculosis, and leukemia. Her medications are levothyroxine and hydrocortisone. She is allergic to penicillin with skin rash and pruritis. Her temp is 100 F and CBC with diff. shows anemia and neutropenia. I am suspicious of one disease. What disease is ON TOP of my differential? 😕

lymphoma

 

[FootDocStudent]

lymphoma

Dr House says: No not lymphoma. Try again. 😎

 

[WaveOR]

Dr House says: I have a 4 year old Japanese American female with bilateral bulging eyes, suffering from thirst despite hydration, with red crusty sores on her trunk, scalp, dorsum of the hands and feet, deafness, trouble walking normally, weakness and tingling in the feet and ankles, and swollen lymph nodes in the neck and thighs and trunk for the past 1 year. She has a past medical history of hypopituitarism. Her family history consists of sarcoidosis, tuberculosis, and leukemia. Her medications are levothyroxine and hydrocortisone. She is allergic to penicillin with skin rash and pruritis. Her temp is 100 F and CBC with diff. shows anemia and neutropenia. I am suspicious of one disease. What disease is ON TOP of my differential? 😕

Hand-schuller-christian disease (multifocal unisys Langerhans cell histiocytosis)

 

[347932]

If I may, I'd like to suggest that every time you post a new case, you start a new thread. It gets tiresome having to scroll through all the old stuff to get to the new stuff. That's just me.

I like the previous posters diag 😀!

 

[krabmas]

If I may, I'd like to suggest that every time you post a new case, you start a new thread. It gets tiresome having to scroll through all the old stuff to get to the new stuff. That's just me.

I like the previous posters diag 😀!

At the top of the thread there is a link to read the first unread post. click this. It takes you directly to the 1st posting that you have not yet read.

This case was in its own thread, but we never got the diagnosis. So now it is here.

 

[Myshoea]

I would suspect syphillis, perhaps a secondary stage congenital syphillis. Sores on the feet and hand, swollen lymph nodes, slapping gait ( difficulty walking) all suggestive of advanced stage syphillis.

 

[Myshoea]

hermansky pudlak syndrome = albinism with hemorrhagic diathesis

I actually saw a similar case on mystery diagnosis where subject was misdiagnosed in her teens with chrohn's disease and had to carry a colostomy bag into her 30's when she was eventually correctly diagnosed. It was definitely a unique case...

 

[347932]

At the top of the thread there is a link to read the first unread post. click this. It takes you directly to the 1st posting that you have not yet read.

This case was in its own thread, but we never got the diagnosis. So now it is here.

Thanks!! I didn't know about this function.

 

[krabmas]

Thanks!! I didn't know about this function.

SDN will be a whole new experience now!

 

[FootDocStudent]

Hand-schuller-christian disease (multifocal unisys Langerhans cell histiocytosis)

Dr House says: Alleluia! You saved me from an M&M by Princeton Plainsboro! The patient will live! And Cuddy will love me again! 😀
Great job!

 

[347932]

SDN will be a whole new experience now!

LOL truly!

 

[dyk343]

At the top of the thread there is a link to read the first unread post. click this. It takes you directly to the 1st posting that you have not yet read.

This case was in its own thread, but we never got the diagnosis. So now it is here.

I didnt know about this either and I have been following these threads for a couple years now...