Boot camp day #1: A monk with fever and salivary gland swelling

40 year old Japanese monk, a Buddhist priest to be precise, presented with 5 day history of fever and left "salivary gland" swelling.

Past medical/surgical, social, travel, etc. history has been unremarkable except his diabetes. Married with a few kids, one wife, no recent travel to anywhere.

And anything else..., oh ya,he had a cat of unknown name !!. Reportedly it was healthy.

My way of approaching this case was following..

1:You can not be certain that swelling was from enlarged salivary gland. Turns out he had more than two "lymphadenopathy" which led me to the category of generalized lymphadenopathy.

Glad I did not start with DDx of salivary gland swelling which would have included stones, cysts, tumors, Sjögren, bacterial infections, viral(CMV,EBV,HIV,flu) infections etc.

2:DDx of generalized lymphadenopathy due to "infection".
The list can very long, but I was lucky enough to include 6 important cat bite related bacterial infections.

Staph. , Strept., anaerobe, Pasteurella, Bartonella, and Rabies.

3:Aoki's pearl on DM
DM hides following three:
1)Anatomy (Hx and Px can not tell you where the lesion is = needs CT)
2)Organism (Can not expect prototypical organism based on clinical informations. ie. cellulitis by cryptococcus)
3)Severity (Patient may be smiling while going down into septic shock.)

Patient had B.henselae infection.