Welcome back for another week of "The Diagnosis." I'd like to take a moment to thank everyone who has been participating in this column – your guesses are what make this so much fun! Now, without further ado, Aubrey's diagnosis from last week's article:
As described in the article, Aubrey spent a lot of time at the nearby barn. There, she would ride horses, but she also came into contact with stray cats chasing after rodents. Any small scratch from an infected cat (or even rodent) could have left Aubrey with cowpox. The diagnosis is interesting on a number of levels. Cowpox was originally transmitted from cows to milkmaids when smallpox was rampant. The story goes that the milkmaids got cowpox, but after getting it became curiously immune to smallpox. Following this observation, an 18th-century scientist named Edward Jenner developed the first successful vaccine.
Smallpox has been declared eradicated since 1980, thanks to international efforts to vaccinate against the disease. Today, the smallpox virus exists only in carefully controlled laboratory settings. Since its eradication, the worldwide initiative to vaccinate everyone against smallpox is no longer relevant. Soldiers receive vaccinations before going abroad, as do scientists working in the vicinity of the virus. Interestingly, cowpox (though rare) persists today, particularly in northern European countries. Recent cases have shown that the cowpox virus can also be carried by cats and rodents; thus, the occasional case results from contact with an infected animal.
This week's patient is a middle-aged photographer named Louis, who returned two days ago from a photo shoot while on a tropical safari through Sundharban, the world's only mangrove tiger reserve. His flight home was horrible – he began feeling extremely ill and ran a high fever for the entire 18-hour flight. Upon reaching his home, he booked an appointment with his primary care physician as his fever entered its second day, along with associated rigors (shaking or shivering due to fever). During his examination, he shows the doctor strange bruises he claims have suddenly appeared within the past 24 hours. The doctor recommends some fever-reducing agents, but Louis's fever persists for another week. After his fever breaks, he calls the physician again and complains that he experienced extreme pain in both of his legs during his fever – even after taking Tylenol.
Upon the physician's recommendation, he comes in for another appointment. His body temperature is back to normal, but the doctor notices strange redness on both his forearms and his calves. In checking the patient's throat for inflammation, the physician also notices some bruising toward the back of the roof of the patient's mouth. The physician recommends that Louis see a dentist for an oral examination.
The dentist does not reach any conclusions as to the cause of the oral bruising, but Louis does experience gingival hemorrhage from the dentist's mild pressure during examination.
Now it's your turn: Leave a comment guessing the patient’s diagnosis! If you have any questions, perhaps about the results from a test you as a doctor would run on the patient, feel free to pose those as well and I will answer to the best of my ability. I will not be replying to guesses about the diagnosis – only to questions about test results not listed here. Best of luck!
