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Severe pneumonia in children: Causes, diagnosis, and treatmentVaccines have substantially reduced the incidence ofpediatric pneumonias caused by Haemophilus influenzae type band certain serotypes of Streptococcus pneumoniae. However,other organisms are being identified more frequently, includingmethicillin-resistant Staphylococcus aureus (MRSA) and serotypesof S pneumoniae that are not covered by the pneumococcalvaccine. Although chest radiographs are still a basic componentof the assessment of pneumonia, CT scans are increasinglybeing used to differentiate effusion from empyema and consolidationand to evaluate for pleural fluid loculations, lung abscesses,and lung necrosis. ß-Lactams, particularly extendedspectrumcephalosporins, remain an important cornerstone ofthe treatment of complicated pneumonia. In areas where community-acquired MRSA is a concern, empirical coverage for thispathogen should be considered in patients with a severe ornecrotizing pneumonia. (J Respir Dis. 2008;29(2):85-92)
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A Woman With Delirium From Diabetic KetoacidosisMucormycosis, an angioinvasive yeast infection of the Mucorales order of the class of Zygomycetes, often grows in patients with diabetes mellitus, especially in the presence of diabetic ketoacidosis.
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Importance of CEA as a Tumor MarkerDuring investigation of a long-standing iron-deficiency anemia, a 67-year-old woman was found to have cecal colon cancer, Duke's stage B. A right hemicolectomy was performed at that time, and she had periodic follow-up examinations. Four years later, during a routine outpatient visit, her carcinoembryonic antigen (CEA) serum level was found to be 27.7 ng/mL (upper normal limit, 5 ng/mL). Four months earlier, her CEA level had been normal.
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NeurofibromatosisA 19-year-old man was referred for further investigation of multiple pigmented cutaneous lesions.
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Underarm Eruption in a Teenaged BoyTopical steroids and antifungals have not only failed to resolve the bilateral rash; the teen says they’ve made it worse. Your Dx?
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Image IQ: Rash with Chills, Neck Pain, Acute FeverRash began with one lesion followed by tender, disseminated eruption; fevers spiked to 102°F. Test your visual diagnostic skills.
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Sexually Transmitted Diseases: Recognizing Telltale Skin Lesions Disseminated Gonococcal InfectionTelltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.
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Rash Around the Mouth of a 5-year-old ChildThe eruption has been present for 1 year and is restricted to the perioral region. What is included in your differential?
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Woman With Type 2 Diabetes and AcromegalyA 43-year-old woman presented withuncontrolled type 2 diabetes mellitus.Her hemoglobin A1c level was 12%,and self-measured glucose levels hadbeen above 400 mg/dL for 3 months.She was taking insulin 70/30,70 units twice daily.
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Suture GranulomaAn 80-year-old woman presented with recurrent abdominal pain for 1 month, constipation, and vomiting. She had no diarrhea, rectal bleeding, or weight loss.
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Cullen Sign in PancreatitisA 72-year-old woman with acute abdominal pain and vomiting was brought to the hospital. The patient had no significant medical history and was taking no medications.
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Hilar Mass with Venous EncroachmentA 56-year-old man, who had a history of cigarette smoking, noticed a sudden swelling in his neck, mainly on the right side. Shortly thereafter, his right arm became enlarged.
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Man With Chronic Eustachian Tube Dysfunction, Otitis Media, and Hearing LossA 31-year-old man presents with a2-week history of a constant, dull acheand hearing loss in the right ear. Healso complains of intermittent sharppains that are usually followed bydrainage through the external auditorycanal. Another practitioner diagnosedacute otitis media with tympanic membraneperforation, for which he prescribeda 10-day course of amoxicillin.The patient completed the regimen buthas obtained no relief.
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Comparative Effectiveness Research-Part 2: The Impact on Decision MakingAs publicly funded health care payment programs have grown over decades because of demographic shifts and expansion of coverage, comparative effectiveness research (CER) has emerged to address value in health care. The American Recovery and Reinvestment Act of 2008 (ARRA) included $1.1 billion for CER initiatives, and the new health care legislation created the Patient-Centered Outcomes Research Institute, which will be funded with $500 million or more annually. In these efforts exist the promise to create informed decisions that will improve health care at both the individual and population levels.
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Keratoconus With Corneal HydropsThis 20-year-old woman with Down syndrome has bilateral keratoconus, a common, noninflammatory, paracentral corneal ectasia that is occasionally hereditary. Symptoms vary from none to severely blurred vision. Opacity of this patient's right cornea developed after her eye had teared excessively for 1 day, during which time she continually rubbed it.
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Chylothorax After Debridement of Necrotizing FasciitisA 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever.
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Eternal SpringsDoctors, especially primary care doctors, love stories. We love hearing them from patients and telling them to one another. “Anecdotal learning” it’s called by some (somewhat derisively because it’s not science).
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Stevens-Johnson Syndrome Due to Levofloxacin HypersensitivityLevofloxacin, 500 mg/d, had been prescribed for a 74-year-old woman who had a urinary tract infection. The patient had type 2 diabetes and hypertension. She was allergic to sulfa drugs.
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Immunosuppression and Infection Risk in SOT RecipientsWith the introduction of immunosuppressive drugs, solid organ transplant (SOT) has progressed such that potential recipients significantly outnumber available organs. In 2007, there were 14,394 donors of 28,353 organs, but 98,645 persons were on a waiting list as of March 2008.1
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Social Media and Medicine: A Winning CombinationDr Farris Timimi, Assistant Professor of Medicine at the Mayo Clinic and Medical Director of the Mayo Clinic Center for Social Media, discusses the potential of social media to change the landscape of clinical practice.
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Retroperitoneal FibrosisFor about 2 weeks, a 61-year-old woman with diet-controlled diabetes and hypertension had fatigue and generalized weakness. For the past 3 months, she had had poorly localized back pain and bilateral flank pain. She denied dysuria, fever, decreased urinary output, or weight loss.
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Familial Benign PemphigusFor 25 years, a 74-year-old man had an intermittent, painful, and pruritic rash that caused cracking and erosions in the axillae and groin. It worsened with sweating and in the summer and also when clothing or skin rubbed against the eruption. The patient’s father, a paternal uncle, and all 3 of the patient’s daughters had a similar rash. Cetirizine and a combination of xipamide, bacitracin ointment, clotrimazole, and triamcinolone cream were prescribed to treat the rash.
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Further Evidence That HTLV Protects Against HIV ProgressionPrevious case reports have suggested an association betweenhuman T-cell lymphotropic virus (HTLV) types 1 and 2infection and chronic nonprogressive HIV infection. Evidenceis lacking about the specifics of how the two are related. Wereport 2 cases of chronic nonprogressive HIV infection (of9 and 13 years' duration, respectively) in women in whomHTLV coinfection was diagnosed. These cases provide clinicalsupport that HTLV coinfection may serve as a protective factoragainst progression of HIV infection. Possible reasons for thisrelationship and potential future research are discussed.[Infect Med. 2008;25:416-420]
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Case In Point: An unusual mediastinal massThe authors present a case that demonstrates the diagnostic challenge of mediastinal tumors. They describe the clinical presentation of a patient who had a central endobronchial tumor that was identified as a primary mediastinal spindle cell neoplasm.
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Benzocaine-induced methemoglobinemia in bronchoscopyBenzocaine-induced methemoglobinemia has been a well-documented illness that is usually simple to cure but can be life-threatening if not recognized. As the use of "scope" procedures becomes more commonplace, the early recognition of hypoxemia resulting from methemoglobinemia is essential. The authors report a case of benzocaine-related methemoglobinemia following bronchoscopy.
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Cyclospora cayetanensis and AIDSA 32-year-old Hispanic woman with AIDS presented with a 1-month history of diarrhea; abdominal bloating and cramps; loss of appetite; and pronounced fatigue, malaise, and weight loss. She had no fever or chills and was not vomiting. Her CD4+ cell count was 12/µL. Results of a routine microscopic examination of stool for ova and parasites were negative; an acid-fast stain of stool demonstrated oocytes of Cyclospora cayetanensis measuring 8.8 mm in diameter (pictured, magnification ×1,000). This is about twice the size of the Cryptosporidium parvum oocyte, which typically is 4 to 5 mm.
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Prolapsed ColostomyA 43-year-old woman was hospitalized with a 3-day history of fever and back pain. She was malnourished and seropositive for HIV infection. Results of blood and sputum cultures were negative. A community-acquired pneumonia was diagnosed. Chest film findings and the clinical presentation were inconsistent with Pneumocystis carinii pneumonia.
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Two Signs of DermatomyositisThe “shawl sign” and the heliotrope rash: two skin signs that are pathognomonic of dermatomyositis. Here: a close-up look.
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Infantile Perianal Pyramidal ProtrusionFor several months, a 52-year-old woman had nausea, mild dysphagia with solid food, vague abdominal pain, and diarrhea. The patient denied hemoptysis, hematochezia, and melena. Lansoprazole and dicyclomine provided minimal relief of her symptoms.
