NBME 11: WTF is wrong with this baby???

[MonsterHospital]

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1 year old boy had 6 days of high fever (103F), 2 days of severe diaper rash, redness and swelling of his hands and feet, red face and lips, injected conjunctiva, bilateral cervical lymphadenopathy, S3 gallop w/ no murmur and clear lungs. Which of the following pathologic findings is most likely in this patient?

a) acute arteritis with aneurysms in coronary arteries
b) epidermal hyperplasia with epidermal microabcsesses and parakeratosis
c) granulomas with caseous necrosis in cervical lymph nodes
d) granulomatous arteritis in cervical and temporal arteries
e) paracortical lymphoid hyperplasia with eosinophilic intranuclear inclusions in perihilar lymph nodes


...I don't even know where to begin on this one. What does this kid have? I think he might have kawasaki's...anyone know?

 

[The kitchen sink]

1 year old boy had 6 days of high fever (103F), 2 days of severe diaper rash, redness and swelling of his hands and feet, red face and lips, injected conjunctiva, bilateral cervical lymphadenopathy, S3 gallop w/ no murmur and clear lungs. Which of the following pathologic findings is most likely in this patient?

a) acute arteritis with aneurysms in coronary arteries
b) epidermal hyperplasia with epidermal microabcsesses and parakeratosis
c) granulomas with caseous necrosis in cervical lymph nodes
d) granulomatous arteritis in cervical and temporal arteries
e) paracortical lymphoid hyperplasia with eosinophilic intranuclear inclusions in perihilar lymph nodes


...I don't even know where to begin on this one. What does this kid have?

Looks like Kawasakis, so choice A.

Just my guess.

 

[Aclamity]

1 year old boy had 6 days of high fever (103F), 2 days of severe diaper rash, redness and swelling of his hands and feet, red face and lips, injected conjunctiva, bilateral cervical lymphadenopathy, S3 gallop w/ no murmur and clear lungs. Which of the following pathologic findings is most likely in this patient?

a) acute arteritis with aneurysms in coronary arteries
b) epidermal hyperplasia with epidermal microabcsesses and parakeratosis
c) granulomas with caseous necrosis in cervical lymph nodes
d) granulomatous arteritis in cervical and temporal arteries
e) paracortical lymphoid hyperplasia with eosinophilic intranuclear inclusions in perihilar lymph nodes


...I don't even know where to begin on this one. What does this kid have? I think he might have kawasaki's...anyone know?

kawasaki's. usually the red face/lips, strawberry tongue, and injected conjunctivae can only mean Kawasaki's, Scarlet fever, and Toxic Shock Syndrome. The swelling and S3 gallop make it more likely Kawasaki's (obviously with Scarlet you'd have a history of strep infection and sandpaper rash, and with TSS you'd be hypotensive and stuff)

 

[scaredoflife]

kawasaki's. usually the red face/lips, strawberry tongue, and injected conjunctivae can only mean Kawasaki's, Scarlet fever, and Toxic Shock Syndrome. The swelling and S3 gallop make it more likely Kawasaki's (obviously with Scarlet you'd have a history of strep infection and sandpaper rash, and with TSS you'd be hypotensive and stuff)

👍

 

[vladmoney]

Can someone please explain what answer E is trying to refer to? (just trying to understand what all the options mean)

 

[MrBeauregard]

Can someone please explain what answer E is trying to refer to? (just trying to understand what all the options mean)

Paracortical lymphoid hyperplasia would refer to the T-cell zone in the lymph node enlarging, as can happen when the body mounts a robust cell-mediated response. I assume the eosinophilic intranuclear inclusions are Cowdry A bodies, maybe pointing to CMV pneumonia or something. Who knows.

 

[MonsterHospital]

Paracortical lymphoid hyperplasia would refer to the T-cell zone in the lymph node enlarging, as can happen when the body mounts a robust cell-mediated response. I assume the eosinophilic intranuclear inclusions are Cowdry A bodies, maybe pointing to CMV pneumonia or something. Who knows.

Chowdry A inclusions would be specific HSV or VZV, I believe...they're listed specifically under "HSV identification" on p. 185 of FA 2012. Someone correct me if I'm misunderstanding that.

 

[HelpPleaseMD]

http://en.wikipedia.org/wiki/Cowdry_bodies

 

[GTP]

looks like kawasakis, so choice a.

Just my guess.

+1

 

[Kaputt]

Paracortical lymphoid hyperplasia would refer to the T-cell zone in the lymph node enlarging, as can happen when the body mounts a robust cell-mediated response. I assume the eosinophilic intranuclear inclusions are Cowdry A bodies, maybe pointing to CMV pneumonia or something. Who knows.

I agree, probably refers to a herpesvirus infection.