The Gorgas Courses in Clinical Tropical Medicine

Selected Cases Seen by 2009 Course Participants

The Gorgas Courses in Clinical Tropical Medicine are given at the Tropical Medicine Institute at Cayetano Heredia University in Lima, Perú.  For the ninth consecutive year, we are pleased to share interesting cases seen by the participants that week during the February/March course offerings.  Presently the 9-week Gorgas Course in Clinical Tropical Medicine is in session.  New cases will be e-mailed every Monday/Tuesday for the next 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.

David O. Freedman & Eduardo Gotuzzo
Course Directors

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 Perú 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 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]. Indirect laryngoscopy was negative.  Chest was clear.  No lymphadenopathy or hepatosplenomegally.

Laboratory Examination:  Normal chest x-ray.   Normal hematology and liver function.  Diagnostic procedures were performed on the lesions.

Click here for Diagnosis & Discussion about this case