The Gorgas Courses in Clinical Tropical Medicine

Selected Cases Seen by 2011 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 eleventh 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 posted 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:  39 year old male with 4 years of diffuse nodular subcutaneous lesions with no initial diagnostic workup.  Hemoptysis 1.5 years ago with chest x-ray at that time showing single LUL cavity and alveolar infiltrate.  TB therapy started despite negative smears and cultures. 6 months ago developed gait abnormality, blurred vision, and intracranial hypertension.  Progressive weight loss but no demonstrated fever or night sweats.

Epidemiology:  Born and lives now in Lima.  1983-2003 lived in the jungle as a suspected narcotics trafficker.  Incarcerated for 3 years in the jungle and the past 1 year in Lima.  Known TB contacts.  Alcohol abuser.

Physical Examination:  T 37°C, RR 16, HR 90, BP 110/60.  Alert x 3, Glasgow score: 15.  Extensive nodular subcutaneous lesions and subcutaneous masses on the scalp, thorax and on the limbs [Image A].  Left knee arthritis with extensive effusion [Image B].  Remote memory loss, blurred vision, no meningeal signs.  Normal fundi.

Laboratory:  (on admission to our hospital)   Hematocrit 21.  WBC 13,5 (92 PMN, 0 Eos, 3 M, 15L).  Plt. 527,000, Bili normal, Alk P 220, GGT 66.  VDRL, HIV, HbSAg negative.  Current CXR, Chest CT, and brain MRI are shown [Images C, D, E].  Brain biopsy 3 months earlier at another hospital had shown acid fast organisms with negative culture for MTB or bacteria.

Click here for Diagnosis & Discussion about this case