Making My First Diagnosis

At school, we are required to interview patients twice a semester. During my recent clinical encounter, I had the opportunity to interview a 12 year old boy who initially presented with conjunctivitis. The child was prescribed eye drops that did not seem to help. Soon, he developed a wart-structure on his eye. After a few days his entire cheek was swollen. As most of these interviews go, I was initially lost as to what this child could possible have. So I stumbled onto the social history and asked him he had any pets. He did not, but he and his mother did reveal to me that the child had been playing with stray cats. Since I was relatively fresh on microbiology, this was setting off alarm bells in my head. After completing my interview, I conferenced with my preceptor. Upon completion of recounting my interview, my preceptor asked me if I had a guess about the potential diagnosis. I hesitated for a second, but I ventured a guess: “Bartonella?” My preceptor was shocked. Apparently they had sent out for a Bartonella test earlier that day and he was impressed that I had figured that out. I was pretty happy with my performance. Normally, when my preceptor asks me for a diagnosis, I have no idea what is going on. It was really amazing to do an interview and have your suspicions validated. I guess that comes with learning and understanding the material. I certainly hope that this trend continues!!