Prior to moving on to this week's mystery diagnosis, I'd like to take a moment to congratulate all those who participated in last week's diagnosis! Congratulations to those who picked up on the honey hint and guessed that little Elijah was suffering from botulism. Botulism is caused by Clostridium botulinum bacteria, which resides in dust and dirt and can contaminate honey if it comes into contact with it. As mentioned in the article, Elijah had a mild cold about ten days prior to his sudden loss of appetite. In the interest of getting him to take his medicine and to help soothe his sore throat, his parents fed him a spoonful of honey after each dose. While this would be no problem for anyone over the age of one, young babies lack the immune response to fight off the spores, and Clostridium botulinum multiplies inside the infant's intestine, producing a toxin called botulinum. This toxin disrupts the ability of a nerve to signal the adjacent muscle to contract, resulting in difficulties eating, breathing, and moving. With the support of the hospital staff and BabyBIG®, a human-derived botulism antitoxin, Elijah has made a full recovery.
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This week's mystery surrounds a young girl named Aubrey, who loves horseback riding. Every day after school, she heads over to the barn behind her house and tacks up her favorite pony, a little Highland called Comet. She stays out until dinner time, riding on the trails, practicing her jumps, and playing with the stray cats that wander into the barn to chase after mice.
Aubrey's mother recently called her pediatrician about a small welt on her cheek. She had noticed it a few days prior, when Aubrey came home from the barn, at which point it just looked like a little cut, but is beginning to look infected. Furthermore, a similar cut seems to have appeared on Aubrey's hand. The pediatrician had recommended applying some Neosporin to prevent infection and wrapping both cuts to keep them clean, but didn't seem convinced these sores are anything out of the ordinary. Aubrey's mother was hesitant to accept this advice. She had already been applying her homemade antiseptics to the lesion, and generally refused to use any unnatural treatments, as Aubrey's doctor knows (Aubrey's mother is active in the anti-vaccination movement). However, after considering that her own ointments have not yet appeared at all successful, she concedes. She follows the doctor's recommendations, only to watch as the lesions continue to grow.
It's now been about a week since Aubrey's mother first noticed the first cut, and now Aubrey's wounds are oozing both pus and blood. Aubrey is in a great deal of pain; her distress seems disproportional to the size of the wounds. Her mother continues to apply Neosporin and whatever home remedies she can find online, but it seems Aubrey's lesions is are no ordinary scrapes. Additionally, Aubrey has begun demonstrating flu-like symptoms. Her mother's soups have aided somewhat with her sore throat, but she remains feverish and lethargic.
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!
