November 2003: Case Study 2

While researching her family tree, MR finds her mother?s journals. The journal?s entries are from 1947, while MR?s mother was growing up in Brooklyn, NY. MR is particularly interested in the entries pertaining to her grandmother?s last days.

According to the journal, MR?s grandmother developed a high fever, severe headache, backache, and malaise.These symptoms were followed by a maculopapular rash in her mouth, on her face, and on her forearms. The rash progressed into papules, then vesicles and pustules. As the severity of the rash progressed, it also spread to her trunk and legs.

The journal entries never provide a name for the disease from which MR?s grandmother died. So, MR brings the journals to the local pharmacy. She asks the pharmacist to read the entries pertaining to the last 2 weeks of her grandmother?s life. From the information provided, MR would like the pharmacist?s opinion on her grandmother?s illness.

What contagious disease might MR?s grandmother have died from?

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The pharmacist suspects that the disease described is smallpox. The clinical course described in the journal entries is consistent with smallpox. The other clues that would lead the pharmacist to suspect smallpox are the time and location of the entries. In 1947, there was a major outbreak of smallpox in Brooklyn, NY.

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