A 45-yo man was referred for a suspected choroidal melanoma (black arrow). The lesion increased in size on upgaze, but disappeared completely with gentle pressure applied to globe (white arrow). What is the diagnosis?
CNS tumor metastasis
Choroidal melanoma
Toxoplasmosis retinochoroiditis
Cotton wool spot
Vortex vein varix
You are correct. The dynamic nature of this lesion, including its complete disappearance with gentle pressure on the globe in this case, is characteristic of a varix of the vortex vein. Though easily mistaken for a choroidal melanoma or secondary tumor, this condition is entirely benign and visually asymptomatic.
A 58-yo man who recently visited Zambia presents w/ fevers and lethargy. Painful leg swellings 3 days earlier. Malaria test negative. Exam: GCS 12/15, facial swelling, indurated skin lesions. Blood film: extracellular structures. What is the diagnosis?
Human African trypanosomiasis
Leptospirosis
Secondary syphilis
Malaria
Dengue fever
You are correct. In human African trypanosomiasis (HAT), also known as sleeping sickness, the typical inoculation chancre is characterized by a circumscribed painful indurated papule, accompanied by regional lymphadenopathy or inflammation of adjacent tissue. Characteristic trypanosoma trypomastigotes are seen on blood film. Transmitted by the tsetse fly, HAT is characterized by a hemolymphatic followed by a meningoencephalitic stage. Tx consists of suramin or melarsoprol. The patient recovered completely after tx w/ suramin.