The Gorgas Courses in Clinical Tropical Medicine

Selected Cases Seen by 2009 Course Participants

History:  29 yo female presents with 2 week history of several lesions in a linear distribution over the right elbow.  More recently she had developed similar lesions over the left shoulder.  Each lesion began as a painless plaque and then developed serous secretions.  Cultures had grown S. aureus and she was referred to us for suspicion of MRSA when there was no response to clindamycin and first generation cephalosporins.  No fever, weight loss, or systemic symptoms.  No past medical history.

Epidemiology:  Lifelong resident of Lima; interior decorator; very active, especially surfing at many of Lima’s beaches.  No travel to the Amazon in the past 5 years.  6 weeks prior to the illness she had traveled to Marrakesh and Fez, Morocco and spent 1 night camping in the sand dunes.  No pets at home.  No history of TB or TB in close contacts.  No illicit drug use.

Physical Examination:  Afebrile, healthy appearing.  Heart, lung, and abdomen normal.  No hepatosplenomegaly.  5 cutaneous lesions were present [Images A,B,C,D].  A single painful lymphnode was present in the right axilla.

Laboratory Examination:  Hemoglobin 12.7, WBC 5.0 with normal differential count.  Liver and renal function normal.  Albumin normal.

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