#IDBoardReview Case Studies a Hit on Twitter

A 20-year-old female, recently returned from the US Virgin Islands and Indonesia, presents with a fever, a headache, and muscle pain. While traveling, she says she developed a faint rash, which persists. Upon examination, it is discovered that she has conjunctivitis, fluid around her lungs, and renal insufficiency. She reveals that during her travels she swam in streams and ate unpeeled fruits.

What afflicts her? It could be disease caused by a mosquito-borne virus, such as malaria, dengue, chikungunya or Zika, though this patient lacks some key symptoms for those diagnoses. The same is true for typhoid or paratyphoid fever. Rickettsial bacteria could also be the culprit, but these infections are usually milder in young people like this patient.

Ultimately, she is diagnosed with leptospirosis, a bacterial infection often caused by exposure to contaminated water. Her recent history of swimming in freshwater is a key clue.

Physicians of diverse specialties and locations puzzled over and ultimately solved this diagnostic mystery on Twitter, where it was shared as part of an ongoing and popular daily feature hosted by IU’s Infectious Diseases Fellowship Program. The program’s director, Saira Butt, MD, calls it “Infectious Diseases Board Review.”

The feature (and its accompanying hashtag, #IDBoardReview), is nominally designed to help would-be specialists in Infectious Diseases prepare for their Board exams. But it’s become very popular with colleagues beyond this group, said Butt.

“We have regular participation from hospitalists, pathologists, dermatologists, and others,” she said. “And it’s not just in Indiana, or even in the United States — we have international engagement, as well.”

Every evening, Butt posts a case study on the @IUIDFellowship account and invites others to guess the diagnosis. (A brief warning: some of the photos that accompany the case studies are graphic, and may disturb the squeamish.) She responds to the suggestions, questions and guesses, and sometimes posts additional information, before finally revealing the correct diagnosis. She says she draws case studies from textbooks, the CDC website, and other Infectious Diseases resources, sometimes making minor alterations to the patients’ histories to further anonymize or vary them.

“Anything that’s out of the ordinary, or just really rare, people will go bonkers over,” Butt said. “Our followers seem to really enjoy the cases that are hard to guess, or ones in which the patient has a dramatic and interesting social history.”

Butt said she started posting the review questions in May without much thought. But almost immediately, the program’s Twitter account and #IDBoardReview started gaining followers. Even more notably, it appears that several other Infectious Diseases fellowship programs around the country were inspired to launch similar features on their Twitter accounts.

“There were some other programs who were sporadically posting review questions and case studies before we started doing it, but it really took off once we started posting daily and using the hashtag,” said Butt. “You can search the hashtag and see that we inspired the Infectious Diseases programs at Yale, Missouri, and Baylor, for example.”

Still, the IU Infectious Diseases program appears to be the only one that posts a case study everyday, she said, and they recently celebrated their 200th #IDBoardReview post.

“I’m saving up some really great questions for the future,” Butt said. “Maybe I’ll use those to celebrate our 500th post!”