The Gorgas Courses in Clinical Tropical Medicine

Selected Cases Seen by 2008 Course Participants

During the past week the Gorgas Course in Clinical Tropical Medicine concluded with a 4-day field trip to Iquitos on the banks of the Amazon River.  Iquitos, with a population of approximately 500,000, is the largest city in the world that is reachable only by air and by river.  The nearest road ends over 400 km away.

Publishing a case report every week for 9 consecutive weeks would not be possible without the assistance of an extremely dedicated group of people.  We would like to thank in particular: Dr. Carlos Seas, Clinical Rounds Coordinator for the Gorgas Courses for case selection, coordination of case summaries and images; and Adam Plier of the Gorgas Center for Geographic Medicine of the UAB Division of Infectious Diseases for all publishing on the Gorgas Course web site.

We hope you have enjoyed this year’s cases.  In August 2008 we will be running the 2-week Gorgas Expert Course and will present a couple more cases during that time.  We will also be in touch in January 2009 at the beginning of next year’s case series.

History:  Previously healthy 2.5 year old female admitted with acute rash and sepsis.  Seven days earlier fever accompanied by multiple erythematous vesiculopapular lesions were noted on the trunk.  Two days of acetominophinen followed by two days of ibuprofen were given.  Two days later the parents noticed a violaceous plaque on the trunk surrounded by marked erythema, high fever, abdominal distention and loss of appetite.

Epidemiology:  Born and lives in Iquitos, all standard national vaccines up to date including yellow fever.  One of her brothers and a cousin have a similar vesiculopapular rash.  No history of trauma or spider or snake bites.

Physical Examination:  Temp 38.5ºC, normal vital signs.  Skin lesions as shown in Image A.  Necrotic and painful ulcer on the trunk surrounded by marked edema and erythema.  The rest of the exam was normal.

Laboratory Examination:  None available at time of consultation.

Click here for Diagnosis & Discussion about this case