From ASTMH2022 in Seattle, Aisha joins the TWiP team to talk about her training and her career, including delivering a baby on an airplane, and they solve the Case of the Heartsick Guatemalan Septuagenarian.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Guest: Aisha Khatib

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Links for this episode

• Aisha delivers baby on airplane (The Varsity)
• Helminth infections during pregnancy (J Travel Med)
• SARS-CoV-2 transmission during air travel (Curr Op Inf Dis)
• Letters read on TWiP 210

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Case Study for TWiP 210

We are consulted about a rash.  A male in his mid 60s originally from Hong Kong with PMH of T2DM, Hypertension, BPH, Hepatitis B infection, COPD (not on home o2), current smoker, ESRD  with right chest cath on dialysis (MWF) presented to the ED  c/o progressive SOB and DOE for 1 week. 2 weeks prior the patient missed 1 session of hemodialysis. Progressively worsening SOB, DOE, orthopnea began to develop starting one week ago with an associated productive cough with white sputum. Last dialysis was session was 3 days PTA. Pt also began developing nausea and vomiting for 3 days x12 times last week. Pt also started developing diarrhea. Pt has states to have a notable generalized pruritic rash for 3 months that has been worsening. He reports he has been seen by dermatology and was told that the rash is due to certain allergies from food and has been using an unknown cream for 1 month that does not relieve his symptoms. Pt recently admitted for management of bleeding permacath and acute hypoxic respiratory failure likely 2/2 COPD requiring intubation and vent support. Denies recent travel, recent antibiotic use, or sick contacts…but his nephrologist reaches out and is concerned about a certain diagnosis as he says three other patients that come for dialysis have recently been diagnosed with a certain diagnosis.

On exam ee has a diffuse symmetrical rash and is scratching the while time. On careful examination there are small linear scabbed areas between his fingers.

         9.3  

8.97  )———–( 210    

           28.4 

Absolute eosinophil count is >1000

134  |  97  |  51

—————————-<  184

3.8   |  25  |  5.10

Send your case diagnosis, questions and comments to [email protected]

Music by Ronald Jenkees