Top 5 Scariest Medical Conditions (in my humble opinion)

To celebrate Halloween as a med student, thought it would be fun to delve into my (current) Top 5 most disturbing medical conditions/px. I will, however, spare y'all the gruesome images, but you're welcome to search them yourself out of morbid curiosity, but disclaimer, what you will find is defs NOT for the faint-hearted. So w/o further ado...BOOOOOO

#5 - Fournier gangrene 🤢

What is it?

Acute necrotic (cell death) infection of the scrotum, penis, vagina, vulva, or perineum (groin area). 

B/g info

Incidence: 1.6 in 100,000 males (M:F 10:1) (altho I've already come across this > 1 🤮)

Can be: idiopathic (of unknown cause/origin), colorectal, urogenital, or cutaneous origin/spread

Implicated in: anorectal abscesses, UTI, post-op

Comorbidities/Risk Factors

- Immunocompromised/immunosuppressed state

- DM (px 60% of cases)

- Morbid obesity (BMI > 40 if asx, BMI > 35 if sx) 

- Alcoholism

- Liver cirrhosis 

- Crohn's

- SLE 

- HIV

- Malignancies 

- Insufficient/abnormal blood supply to pelvis (e.g. atherosclerosis)

Prognosis

Pot life-threatening dependent on disease severity and if any delay in px and tx/mx

Signs & Sx

- Fever & malaise

- Tachycardia and hypotension 

- Mod-severe pain & swelling in genital and anal areas

- Fetid suppuration (rankness and smell of affected tissues)

- Cyanotic, erythematous, blistering, oedematous, indurated and pruritic lesion

- Palpable crepitus (crackles and feeling of skin-on-skin mov on rubbing affected area)

- Severe cases → necrosis can extend to parts of the thigh, through the abdo wall, up to chest wall

- N.B. → can have dry or wet gangrene

Tx/Mx

1.  Initial urgent aggressive resus and broad-spec IV abx 

2. Surgical debridement +/- once hemodynamically stable (severity and access dependent) 

3. Source control 

4. If septic shock may req further DVT prophylatic tx

5. Reconstructive surg once the infection under control 

Cx

- Septic shock 

- DKA

- DIC 

- AKI 

- Multi-organ failure 

- prolonged hosp admission

#4 - Alpha-gal syndrome (AGS) 🕷🥩

What is it? 

AKA red meat allergy, tick bite meat allergy. 

B/g info

Allergic reaction to alpha-gal (a sugar molecule found in all mammals except humans, great apes, and Old-World monkeys, also found in gut and saliva of ticks) 

Severity ranges from rashes to anaphylaxis 

Risk factors: ticks (lone star ticks in the US, other ticks not ruled out but no definitive evidence as yet), most reported cases in the US affect adults but all age group susceptible

Signs and Sx

- Pruritic rash / hives

- N/v, reflux, indigestion, diarrhoea

- Cough, SOB, dyspnoea 

- Lips, tongue, throat and/or eyelids swelling

- Dizziness, lightheadedness, LOC 

- Coma, death

Tx/Mx

- Avoid consuming mammalian meat 

- Tick prevention - void grassy, bushy, and wooded areas, tx clothing and gear w permethrin

- Check clothes, gear, pets for ticks when inside 

- Seek immediate help from health professionals if suspect exposure 

- Pharm tx depends on severity of allergy reaction

#3 - Primary amoebic meningoencephalitis (PAM) 🧠💀

What is it?

Rare brain infection due to Naegleria fowleri (an amoeba), usually fatal  

B/g info

153/157 cases in the US has been fatal

5 documented survivors in North America (4 in the US, 1 in Mexico) 

Pathphys: when exposed to contaminated water through the nose → amoeba travels through nose via olfactory nerve to brain → innoculation period 1-12/7 → death w/in 1-18 days of sx onset

Difficult to dx → rapid disease progression (postmortem autopsy dx) and similar signs/sx to bacterial meningitis

Signs & Sx

Stage 1: severe frontal headache, n/v, fever

Stage 2: neck stiffness, alt. conscious state, seizures, hallucinations, coma

Tx/Mx

- Broad spec IV abx coverage 

- Corticosteroids 

- Prevention control (currently difficult) 

Cx

Unfortunately almost always fatal

#2 - Hydrophobia 

What is it?

Late-stage px of rabies infection - fear of drinking water (physiological rather than psychological trigger)

B/g info

Involuntary and painful laryngeal (throat) spasms when drinking water or thinking about drinking water

When rabies progresses to this stage, almost always progresses to death

NOT BE CONFUSED W AQUAPHOBIA "typical phobia" where trigger is psychological e.g. past traumatic experiences involving water (near drowning event, aspiration when drinking water) 

Panic and fear experienced in hydrophobia due to anticipation of pain 

Usually occurs when pt contracts furious rabies = rabies resulting in encephalitis (brain inflammation) → encephalitis leads to destruction of nerve cells in brain stem that controls breathing → largyneal spasms → dysphagia and odynophagia → extreme fear and panic on seeing, feeling, tasting, hearing, thinking, drinking water → refusal to drink water regardless of how dehydrated they become → death by dehydration 

Risk factor: where rabies arise endemic i.e. Asia and Africa, children* > adults 

*Children more likely to be bitten by dogs and other animals, be bitten multiple times and for the bites to penetrate skin. They are also more likely to forget to tell their parents about a small non-painful bite → late px → more likely to progress to late stage

Tx/Mx

Prevent rabies infection

If infected → early and aggressive tx to prevent progression to late-stage infection

#1 - Lock in syndrome 😨

What is it?

Cognitively intact and awake BUT nil interaction w outside world save communication via coded eye movements due to quadriplegia and paralysis of lower cranial nerves i.e. pt able to perceive the world around them but can't do anything about it 😱 (honestly sounds like a cond straight from a Black Mirror epi) 

B/g info

Most common cause: stroke involving the ventral pons and midbrain (brainstem stroke) 

Other causes: diseases resulting in severe widespread motor paralysis (e.g. Guillan-Barre syn), trauma, infection, tumours, AVM, toxins, opioid use

Prognosis

Dependent on underlying cause and level of care provided

Favourable prognostic signs 

• early recov of lateral eye movements
• early recov of evoked pot from magnetic stimulation of motor cortex 

If  cause TIA or small stroke → may be transient and pt recover completely 

If  cause partially reversible e.g. Guillan Barre → recvoery over months but usually w/ some residual sx

If cause irreversible/progressive e.g. brain tumour in posterior fossa and pons → usually fatal 

Signs & Sx

- Nil movement save eye movements

- Normal sleep-wake cycles 

- N.B → can be mistaken for being unconsc. b/c lack of motor fn to respond to tests usually used to judge state of consciousnesses, all pt should be tested for whether able to follow instructions on eye blinking, vertical and lat eye movements

Tx/Mx

- Supportive care

        - preventing sys cx of extended immobilization (e.g. DVT, thromboembolism, pneumonia, UTI)

        - provide adequate nutrition (NGT, parenteral feed etc) 

        - prevent pressure inj/ulcers

- Communication training 

        - speech path input 

        - establish comm code w blinking and/or eye movements 

- B/c pt cognitive fn intact ∴ have capacity ∴ can (and should) make own health decisions