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February 3, 2012

Medical Diagnosis Challenge - Case: 33y Female Post Partum

The Isabel tool touts an extensive database of conditions, and we often will test its accuracy with New England Journal of Medicine cases.

About the Diagnosis Challenge

The New England Journal of Medicine (NEJM) publishes interesting presentations of common diseases and unusual cases in the Clinical pathology Conference (CPC) series. These cases are educational and can pose diagnostic challenges even to the expert physicians at the Massachusetts General Hospital.

Using the clinical features of these cases you can evaluate your own diagnostic skills and compare your diagnostic performance to that of the physicians at MGH. If you are registered with Isabel as a client or have a free-trial subscription, you can use the diagnosis reminder system and run through some scenarios to get a list of likely suspects. Clicking on a diagnosis will take you through to various knowledge sources and links available from within Isabel.

Today's Case

Access the full case here (if you are a NEJM subscriber).

A 33-year-old woman was admitted to the intensive care unit (ICU) 16.5 hours post partum because of leukocytosis and gram-positive rods in the blood.

The patient had received routine prenatal care at the same hospital. At 5 and 7 weeks of gestation, ultrasonography performed because of intermittent vaginal bleeding was reported to reveal an arcuate uterus with findings suggestive of a cornual ectopic pregnancy. At that time, diagnostic laparoscopy revealed no evidence of an ectopic pregnancy. Repeat ultrasound examinations at 8 and 9 weeks showed a normal uterus.

Demographic:    Female,  33  yrs from North  America     

Clinical  features entered into Isabel: 

  • leukocytosis  

  • postpartum  

  • bacteremia     

Stop. Before you continue, construct your own:

  1. Differential diagnosis
  2. Final diagnosis.

The Answer:

Differential Diagnoses considered by the MGH panel: Intraamniotic infection; or Postpartum endometritis

Final Diagnosis of the case by NEJM: Clostridium perfingens bacteremia

NEJM Differential Diagnoses included in Isabel: Intraamniotic infection in Obstetrics; or Postpartum endometritis in Obstetrics

Do you think that the NEJM should have included some other important diagnoses in their differential? We would love to hear from you.

Was the final diagnosis given by Isabel?: Yes, Clostridial infections in Infectious

See the below screenshow of how Isabel presented the differential list of possible diagnoses.

NEJM Isabel Case 35 screenshot

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