Interesting Medicine

Rabies is well known as a fatal infectious disease transmitted through the bites of rabid mammals. When it presents with paralysis, however, it may be clinically indistinguishable from Guillain- Barre syndrome. Here the authors describe this fascinating disease with some spectacular images.

Seema Biswas
Editor-in-Chief

Atypical rabies with MRI findings: clue to the diagnosis

An education in pathology

The authors present a case of secondary syphilis complicated by HIV infection. The pictures and description of disease process form an engrossing lesson in pathology.

Seema Biswas
Editor-in-Chief

Ulceronodular syphilis (lues maligna praecox) in a person newly diagnosed with HIV infection

Adverse events

A newborn screening test for galactosaemia is designed to identify affected infants and avert clinical effects with the prompt withdrawal of lactose and galactose from the diet. Failure of this test to detect the disease may have catastrophic effects. Here we learn from the factors that affect the effectiveness of the test in order to avoid instances of failure of diagnosis in the future.

Seema Biswas
Editor-in-Chief

Problems with the new born screen for galactosaemia

Diagnostic pitfalls

Here the authors discuss the difficulties in differentiating microbial (in particular tuberculous) causes of intrathoracic lymphadenopathy and sarcoidosis; indeed, sarcoidosis may occur in patients with previous microbial infection just as TB occurs in patients who are HLA B27 positive. Case reports are an excellent platform for diagnostic debate and the discussion of pitfalls.

Seema Biswas
Editor-in-Chief

Concomitant axillary mycobacteriosis and neuro-sarcoidosis: diagnostic pitfalls

Rare side effect of treatment

Here the authors present a case of unilateral onycholysis in a patient receiving an EGFR tyrosine kinase inhibitor. In addition to describing a possible mechanism for this side effect, the authors also highlight the benefits of targeted therapy.

Seema Biswas
Editor-in-Chief

Unilateral onycholysis in a patient taking erlotinib (Tarceva)

Introducing novel methods of investigation and treatment

Here the authors report two cases of metastatic melanoma resected with the assistance of an intraoperative handheld positron emission tomography (PET) probe. The probe was used to identify hypermetabolic lymph nodes and after resection the probe reading returned to background levels. At follow up the patients remained disease free.

Seema Biswas
Editor-in-Chief

The use of intraoperative PET probe to resect metastatic melanoma

Case reports offer level IV evidence ranked well below randomised control trials and meta-analyses.

http://healthpolicyandreform.nejm.org/?p=14876&query=TOC

What role do case reports have then in the medical literature? Certainly, the report of adverse events, the opportunity to discuss diagnostic pitfalls, present novel methods of investigation and treatment and, of course, present cases of enormous interest and concern.

Over the next few weeks we hope to present a series of reports that illustrate these examples of the relevance of case reports in modern evidence based medicine. Here is the first…

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A near miss

A 12 year old healthy girl presents with unilateral periorbital swelling, purulent discharge, pain in her jaw and palpable cervical lymphadenopthy. An initial diagnosis of preseptal cellulitis is made, but, in spite of a course of conventional broad spectrum antibiotics, the symptoms progress. A careful history and further investigation leads to a diagnosis of cat scratch disease and treatment is adjusted.

Seema Biswas
Editor-in-Chief

Periorbital cellulits – a mistaken diagnosis!