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Internal Medicine

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A 34-year-old woman with a history of three weeks of swelling and tenderness over the dorsum of the left hand, pain, redness, and swelling in her right ankle, intermittent pain in shoulder and knee joints, and a rash on her lower extremities. Here are the key points and findings:

Patient History:

  • Unhoused: Staying in shelters and homes of acquaintances in downtown Los Angeles.

  • Substance Use: Smokes one pack of cigarettes daily, consumes four to six alcoholic beverages daily, occasionally smokes marijuana, and occasionally smokes methamphetamine. No injection drug use.

  • Sexual History: Several intimate partners in the past year.

Physical Examination:

Nader Guma
Manar  Ismail

Key Points:

  • Clinical Presentation: Swelling and tenderness in multiple joints, rash on lower extremities, and elevated inflammatory markers.

  • Risk Factors: Multiple sexual partners and substance use.

  • Laboratory Findings: Elevated leukocyte count, neutrophilia, elevated ESR, and CRP.

Neisseria gonorrhoeae is known to cause disseminated infections, presenting with symptoms such as tenosynovitis, dermatitis, and polyarthralgia, which matches the patient's symptoms.


In February, 27-year-old man is seen for fever, myalgias, arthralgias, and headache of one-day duration. Two days before he became ill, he returned from a skiing vacation with friends in California.

They stayed in a cabin in the woods that had been uninhabited for many months. Rodent droppings were evident in the cabin when they arrived. He has been taking NSAIDS for muscle pain precipitated by skiing.

Exam is notable for fever and meningismus.

A CSF exam shows 400 white blood cells, 97% lymphocytes. The CSF protein is 98, and the glucose is 30 with simultaneous blood glucose of 88; Gram stain is negative.

Which one of the following is the most likely cause of his illness?

  • NSAID-induced aseptic meningitis

  • Lymphocytic choriomeningitis virus

  • Enterovirus

  • Hantavirus

Nader Guma
Amna Khan

Harsh Sura

Has anyone heard of chronic recurrent multifocal osteomyelitis?

Never heard of it.


Which of the following organisms cause sepsis in splenectomized patients?

Streptococcus pneumoniae

Haemophilus influenzae

Neisseria meningitidis

Capnocytophaga canimorsus


Nader Guma



Nader Guma
Apoorva Pandharpurkar

The organism seen on this gram stain is

  • Hemophilus influenzae

  • Neisseria gonorrhoeae

  • Acinetobacter cloacae

  • Moraxella catarrhalis

Nader Guma

Kidney-shaped gram intracellular negative organisms consistent with Neisseria gonorrhea @Everyone


Gram-positive bacilli of clostridium difficile on culture. Of course, we do not do routine culture for this organism but we diagnose clostridium difficile infection with either NAAT (PCR) or EIA for GDH antigen and if positive we do EIA for c-diff toxin A and B.

Apoorva Pandharpurkar
Tarek Slibi
Mizba Baksh
Harsh Sura

Buzz words in infectious disease, Let's play this:

  1. If I say "rabbit".. you say "Tularemia"

  2. If I say "Bull's eye rash".. you say ____

  3. If I say "chitterlings or chitlins".. you say ____

  4. If I say "streptococcus bovis".. you say ____

Please try to answer 2,3, and 4

Israr Khan
Harsh Sura

If you say spaghetti and meatballs, I would say Malasezzia Furfur (tinea versicolor)


Bacteremia from Asymptomatic Bacteriuria Is Both Rare and Hard to Predict

Rahul B. Ganatra, MD, MPH, reviewing Advani SD et al. JAMA Netw Open 2024 Mar 4

Despite guideline recommendations against antibiotics for asymptomatic bacteriuria (ASB; NEJM JW Emerg Med Jun 2019 and Clin Infect Dis 2019; 68:e83), antibiotic treatment for patients with ASB and nonspecific symptoms remains common. In this retrospective study, researchers estimated the prevalence of bacteremia from a urinary source (i.e., isolation of identical organisms from blood and urine cultures collected within 3 days of each other) among 11,600 hospitalized noncritically ill adults with ASB at 68 hospitals in Michigan; data were obtained by standardized review of individual charts and were not simply administrative data. Patients with specific signs or symptoms of urinary tract infection (UTI) and patients who received antibiotics for UTI before blood culture collection were excluded.

Key findings were as follows:

  • Among all patients…

Nader Guma
Mizba Baksh

This gallery contains a spoiler

For each image, please identify whether it is representing streptococci, staphylococci, and enterococci?

Apoorva Pandharpurkar

Enterococci, staphylococci and streptococci in that order.


A 19-year-old young woman has had a slowly progressive ascending paralysis over the last two days. She can no longer walk. One week before she developed neurologic symptoms, she had an episode of fever, cramping abdominal pain, and diarrhea that lasted three days.

Which one of the following was the most likely cause of her gastrointestinal illness?