The Gorgas Courses in Clinical Tropical Medicine

Selected Cases Seen by 2009 Course Participants

History:  57 yo male admitted with a 1-month history of low-grade fever, general malaise, cough productive of white sputum, weight loss (at least 5 kg), progressive dyspnea and painful oral ulcers causing difficult swallowing.

Epidemiology:  Born in and currently works as a farmer in Ancash in the Andean highlands.  Lived more than five years in the jungle regions of Huánuco in central Perú with poorly described history of an episode of malaria at that time.  No history of or close contacts with TB.

Physical Examination:  Afebrile, HR 88, resp 26, BP 90/70.  Chronically ill appearing, no skin lesions, no lymphadenopathy.  Edematous gums with erythematous and granulomatous infiltration, poor dental hygiene with many missing teeth [Images A & B].  Multiple oral ulcers with erythematous infiltration.  Rales bilaterally.  Liver palpated 4 cm below the costal margin.  No splenomegaly.

Laboratory Examination:  Hb 12.9; WBC 12,300 (80% PMNs, 12% lymphs), 673K platelets.  Normal glucose, creatinine, bilirubin and transaminases. Albumin 2.8 (N > 3.5).  Normal urinalysis.  Oxygen saturation was 92% on room air.  Chest x-ray is shown in Image C.

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