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April 2009
Vol. 19 No. 4
Patient Care and Science
EIN: Test Your Diagnostic Skills with the Gorgas Course Case of the Week

The Emerging Infections Network (EIN) is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. Any diagnostic or therapeutic recommendations and all opinions presented are those of the individual contributor. They do not necessarily represent the views of EIN, IDSA (EIN's sponsor), or the Centers for Disease Control and Prevention, which funds the EIN. The reader assumes all risks in using this information.


The Gorgas Courses in Clinical Tropical Medicine, given at the Tropical Medicine Institute at Cayetano Heredia University in Lima, Peru, shares with EIN interesting cases seen by the participants that week during the February/March course offerings. For the ninth consecutive year, course directors David O. Freedman, MD, FIDSA, and Eduardo Gotuzzo, MD, are pleased to bring the course to EIN.

New cases are mailed to EIN members via the listserve every week for nine weeks. Each case includes a brief history and digital images pertinent to the case. A link to the actual diagnosis and a brief discussion follow.

Here is the case from Week 1 (Feb 2, 2009):

The following patient was seen in the outpatient department of the 36-bed Tropical Disease Unit at Cayetano Heredia National Hospital. We thank Dr. Alejandro Llanos and his staff for advice and collaboration in this presentation.

History: Approximately 8 months after moving to the Peruvian jungle, this 25-year-old male biologist developed a firm painless papular leg lesion that subsequently ulcerated. No trauma. No fever, weight loss or systemic symptoms. No cough, hoarseness, respiratory symptoms or otorhinolaryngogical symptoms.

Epidemiology: Born in Lima and lived in Piura in Northern Peru until moving in October 2007 to Madre de Dios to a field station bordering Manu National Park.

Physical Examination: Afebrile. Large ulcerated lesion with raised borders and a clean base on the left leg with small satellite lesions [Image A on website; see URL below]. On examination with a nasal speculum a small ulcer with erythema and raised borders was noted on the middle third of the nasal septum [Image B on website]. Indirect laryngoscopy was negative. Chest was clear. No lymphadenopathy or hepatosplenomegally.

Laboratory Examination: Normal chest X-ray. Normal hematology and liver function.

To view an images as described above, along with results of diagnostic procedures performed on the lesions, please go to this web page:

The diagnosis and discussion follow the images.

E-mail the Emerging Infections Network.

The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public-health community detect trends in emerging infectious diseases.

A joint project of IDSA and the Pediatric Infectious Diseases Society (PIDS) and supported by funding from the Centers for Disease Control and Prevention, EIN tracks emerging infectious diseases and keeps the public-health community up to date with issues that are currently affecting or may soon affect members’ clinical practices.The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. Both IDSA and PIDS members are eligible to join. The EIN listserve allows members to discuss new disease trends and difficult cases. Click here for more information or to join EIN.

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