Hey friends, and welcome back to the 16th installment of Diagnose This! So sorry that it is a bit late, but this weekend has been hectic. So yeah, sorry just have to deal with it.
Okay, so last week was the incredibly worrying case of the little girl with the rash and deteriorating condition. The main concern here is that the patient may have meningococcal disease, a horrible disease that has an unfortunately high mortality rate. Using the “Tumbler Test” (using a glass to press on the rash to see if it blanches) can determine if the rash is haemorrhagic, and therefore not good at all, or not. Blood cultures are arguably the traditional gold standard for diagnosis, with Neisseria Meningitidis being the most common bacteria found (approx. 40-70% of patients will grow this.) Now, as this child has progressed to the septicaemic stage of the disease the prognosis is not looking good. With the non-compliance to the immunisation schedule set by the Australian government these parents have caused the serious injury of their child. Whether or not she dies depends on a number of factors, but this could have been prevented with a simple vaccine when the child was younger. PLEASE. VACCINATE. YOUR. CHILDREN.
Now, onto the next case:
A 68 year old man presents to the GP complaining of swelling of the ankles, weight loss, and fatigue for the past few weeks. Blood tests show hypoalbuminaemia and hyperlipidaemia, with a urinalysis showing massive proteinuria. The doctor also notices the following abnormality on the man’s face:
Urine immunofixation shows the presence of monoclonal proteins.
What type of renal syndrome is occurring in this patient? What rare condition can cause this type of renal syndrome and is characterised by the facial feature of the patient shown? What other findings would confirm this diagnosis?
Bit of a tricky one this week guys, any questions chuck the bloodbonesandbodies crew a message and we will help out as much as possible!
Eugen Hahn was most likely the first physician to perform a renal biopsy in Berlin, 1881! This was performed as part of a nephropexy, the first of which was also performed by Eugen Hahn!
IMAGE CREDIT: Von <span lang=”de” xml:lang=”de”>Unbekannt</span><a href=”//www.wikidata.org/wiki/Q4233718″ title=”wikidata:Q4233718″></a> – Archiv Silesia, Gemeinfrei, https://commons.wikimedia.org/w/index.php?curid=6556959