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Spontaneous Internal Carotid Artery DissectionA 36-year-old man who had collapsedand sustained a bruised right shoulderwas brought to the emergency departmentwith acute emesis, cephalgia,blurred vision, aphasia, and righthemiparesis. He was confused but ableto follow simple commands.
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Penicillin- and Carbapenem-Induced Neurotoxicity: How to Reduce the RiskPenicillin-induced neurotoxicity was first recognized by Johnson and Walker in 1945 after intraventricular administration of benzylpenicillin.1,2 Subsequently, the β-lactams have been shown to have a higher rate of CNS effects than other classes of antibiotics.3,4
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Older Man With Exertional Dyspnea and Leg SwellingA 74-year-old man with a history ofatrial fibrillation presents to hisprimary care physician with dyspneaof 4 days’ duration. The dyspnea developedwhile he was walking as partof his recovery from back surgery forspinal stenosis 1 month earlier. Hebecame progressively short of breathand was unable to carry out his exerciseprogram.
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Achalasia in a Previously Healthy Young ManFor 3 weeks, a previously healthy 24-year-old man had repeated episodes of nonbloody, nonbilious emesis. He denied dysphagia, but he did report a 40-lb (18-kg) weight loss and heartburn.
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Renal Infarction in the Setting of Undiagnosed Paroxysmal Atrial FibrillationAcute renal infarction most often causes flank pain associated with nausea, vomiting, abdominal pain and, less frequently, fever.
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Prevention of Opportunistic Infections in the Solid Organ Transplant RecipientThe successful management of immunosuppression followingsolid organ transplant requires a delicate balance betweenpreventing allograft rejection and minimizing the risk ofinfection. Strategies that may reduce the risk of de novoopportunistic infection and emergence of latent infectionduring the early posttransplant period-specifically infectioncaused by Cytomegalovirus, opportunistic fungi such as Aspergillus and Candida, and bacteria such as Pneumocystisjiroveci and Mycobacterium tuberculosis-are presented in thisreview. [Infect Med. 2008;25:403-415]
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Case In Point: Fever and a chest wall mass in a young manCoccidioides immitis is a di-morphic fungus that causes pulmonary disease with a variety of clinical and radiographic presentations. Miliary pulmonary disease is very uncommon and is found almost exclusively in immunocompromised patients. The authors describe the case of an immunocompetent patient who had disseminated coccidioidomycosis with a miliary pulmonary disease pattern. Obtaining a careful travel history and considering regional fungal infections was integral to making a prompt diagnosis.
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Nasal Perforation From Chronic Cocaine AbuseCocaine abuse is associated with many dermatological manifestations, vasculitides, and infections. Consider this diagnosis in patients with unexplained chronic skin lesions, an ambiguous medical history, previous examinations that found no source of symptoms, labile affect, and delusional behavior.
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Sulfonylurea-Induced Hypoglycemia: The Case Against GlyburideSince it came onto the market in 1983, glyburide has been one of the most popular sulfonylureas. The American Diabetes Association (ADA) recommends the use of these agents as part of a stepwise approach to treating type 2 diabetes mellitus.
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Primary Adrenal InsufficiencyFor 2 weeks, a 43-year-old white female had worsening nausea and multiple episodes of vomiting. Her symptoms began with increased malaise and decreased appetite. The emesis was unrelated to meals and was sometimes accompanied by mild abdominal distention. She had occasional fevers but denied any recent contact with ill persons. She also reported a 12-lb weight loss, decreased energy level, and an increased tan complexion over the past several months.
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Pneumomediastinum as First Presentation of Hypersensitivity PneumonitisSpontaneous pneumomediastinum with subcutaneous emphysema is rare. Alveolar rupture allows air to enter the pulmonary interstitium and penetrate the mediastinum.
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Acquired AngioedemaA 68-year-old man presented to the emergency department (ED) complaining of an itchy rash over his body. His past medical history included hypertension, contact dermatitis, and penicillin allergy.
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Acquired AngioedemaA 68-year-old man presented to the emergency department (ED) complaining of an itchy rash over his body. His past medical history included hypertension, contact dermatitis, and penicillin allergy.
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A Differential Diagnosis of Drug-Induced Aseptic MeningitisDrug-induced aseptic meningitis should be included in thedifferential diagnosis of viral/aseptic meningitis. Cliniciansshould use historical clues in patients presenting with signs andsymptoms of viral meningitis to aid in the differentiation ofdrug-induced aseptic meningitis from other causes of asepticmeningitis. Viruses are the most common cause of asepticmeningitis, with enteroviruses being the most common amongviruses in cases presenting as aseptic meningitis. Ibuprofen iscurrently the most common cause of drug-induced asepticmeningitis. Drug-induced aseptic meningitis is a benign conditionwithout long-term sequelae. The diagnosis of druginducedaseptic meningitis is made by establishing a causalrelationship between the use of the drug and the onset of signsand symptoms, supported by negative tests for infectiouscauses of symptoms and rapidity of resolution after the drugis discontinued. [Infect Med. 2008;25:331-334]
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Depression, Anxiety May Coexist With Persistent RhinosinusitisGreater awareness of mental health issues such as these, along with screening for diseases and providing appropriate treatment, may improve symptom control.
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DermatomyositisThis inflammatory myopathy is believedto be related to immune-mediatedmuscle damage. An increased incidenceof malignancy is associatedwith dermatomyositis (DM), especiallyin patients older than 50 years.
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Abnormal Uterine Bleeding: A Primary Care PrimerAbnormal uterine bleeding can be defined as bleeding that deviates from the patient's normal pattern; it may be heavier, more frequent, or abnormal in timing. Bleeding of any kind in a postmenopausal patient should be considered abnormal unless she is receiving hormonal therapy that is associated with regular cyclic withdrawal bleeding.
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Spontaneous Internal Carotid Artery DissectionA 36-year-old man who had collapsedand sustained a bruised right shoulderwas brought to the emergency departmentwith acute emesis, cephalgia,blurred vision, aphasia, and righthemiparesis. He was confused but ableto follow simple commands.
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Small-Bowel Metastatic MelanomaAn 83-year-old man with a history of hypertension, hyperlipidemia, and diverticulosis was hospitalized because of painless hematochezia of 1 day's duration. Two years earlier, he had undergone surgical excision of a superficial spreading melanoma on his right thigh.
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What Is the Cause of Macrocytosis and Dyspnea in an Older Man?A 78-year-old man presented to theemergency department with a 3-weekhistory of progressive shortness of breathand cough with blood-streaked, yellowishsputum. The patient had dyspnea onexertion limited to 2 blocks, 2-pilloworthopnea, paroxysmal nocturnal dyspnea,and nocturia. Neither fever norchills were present. He had lost 7.2 kg(16 lb) during the last year.
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Breast Abscess After Nipple PiercingA 29-year-old sailor presented with a painless, enlarging, reddish, mobile lump under his left nipple. Four months earlier, while on deployment in the South Pacific, he had his nipples pierced on a whim.
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Space-Age Concussion Assessment Tool Has a Long Way to GoMIAMI -- With the Super Bowl upon us, the long-term effects on some former National Football League players of repeated concussions, including premature Alzheimer's disease-like symptoms, have been the subject of two front-page articles in The New York Times this week. Here from the MedPage Today archives is a major 2005 report on football concussions at all levels of competition.
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Surfer's EarA 35-year-old man, a sea and white-water kayaking instructor, complained of pain and congestion in the right ear. Otoscopy revealed bilateral external auditory canal stenosis with impacted cerumen and otitis externa on the right.
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Wood Smoke, Indoor Air, and AsthmaIn many parts of the country-and for people of all ages-a turn of the calendar to the winter months means more time spent indoors. For patients with asthma, however, an evening spent in front of a crackling fire may simply serve as a trigger for an attack.
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Association Between Sleep Disorders and GERD Explored at ACG MeetingMention GERD and most of patients probably think of heartburn. But the GERD story does not begin and end with the esophagus. The connection between GERD and laryngeal, pharyngeal, and pulmonary symptoms is the focus of a seminar, “An Eye and Nose Opening Experience-Chronic Complications of GERD,” at the upcoming American College of Gastroenterology Annual Scientific Meeting, October 31 to November 2 in Washington, DC.
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Clinical InvestigationThe CDC estimates that more than 850,000 people are living with HIV/AIDS in the United States today,1 with African Americans and Latinos being disproportionately affected.2 Over the past decade, the Latino population in the United States has been growing. In fact, in 2002 for the first time, Latinos surpassed African Americans as the largest US minority group. However, the term "Latino" is applied to a very heterogeneous group from different countries and different cultures.3 In addition, a large proportion of Latinos is undocumented in the United States and thus marginalized from the health care system.
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In COPD, Controlling Acute Exacerbations Remains Key to SurvivalCOPD exacerbations severe enough to require hospitalization are a red flag for mortality. Preventing or delaying the second after a patient is discharged, and each successive exacerbation, is crucial to extending lifespan.
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Orthotopic UreteroceleA 67-year-old woman was admitted to the hospital with fever, chills, unilateral flank pain, dysuria, and urinary frequency and urgency. Her past medical history included several febrile relapses of infection.
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ICD-10 Uptake Poll: Week 1You knew it was coming; you prepared and prepared; you had meetings, you stayed late; you were ready. So, how'd it go?
