Cho, Goto land case report in NEJM

Drs. Christine Cho and Michihiko Goto, Division of Infectious Diseases, have published a rare case in a recent issue of New England Journal of Medicine. The “Images in Clinical Medicine” report outlines the presentation, diagnosis, and successful treatment of a patient with spinal brucellosis.

First author (and recent addition to the faculty) Dr. Cho explained that this case was particularly instructive, not only because brucellosis is a rare diagnosis in the United States, but because the presumptive diagnosis of tuberculosis fit initial findings. The patient regularly traveled to Mexico, presented with symptoms associated with tuberculosis, and radiographic findings initially pointed to this diagnosis. However, the patient had no history or known exposure to Mycobacterium tuberculosis.

“Given the broad differential diagnosis, we obtained blood and tissue samples, which grew Brucella,” Dr. Cho said. This was a surprising finding that made more sense in light of the patient’s statements that he occasionally consumed unpasteurized dairy products. Dr. Cho believes “forming the differential diagnosis and then running the appropriate diagnostic evaluation were key to this patient’s definitive diagnosis.”

Senior author Dr. Goto believes this case also highlights the value of educational methods he found useful when he first entered medicine. “In this era of competitive academic environments, we too often overlook the importance of very basic and intuitive ways to learn medicine: educational case vignettes and impressive representations of them.”