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Woman With Purpura FulminansThe patient is severely ill. Temperature is 39°C (102.2°F). Shortly after admission, she requires intubation with ventilatory support. Hypotension, acrocyanosis, and an ecchymotic rash consistent with purpura fulminans (A) rapidly develop.
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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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Sudden Headache in a Woman With HypertensionA 37-year-old woman presents to the emergency departmentwith a diffuse, sharp, pounding headache,which started 2 hours earlier. She rates her discomfort as4 on a scale of 1 to 10. Neck muscle soreness is also present,but the pain does not radiate.
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Syncope: Causes and TreatmentBecause the causes of syncope are numerous and the diagnostic tests have low yield, this disorder is often difficult to evaluate. Here we describe a practical approach to the workup that can help you rapidly identify serious underlying pathology. We also discuss treatment of the most common causes of syncope.
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Renal Cell Carcinoma Metastases to the LungA 2-month history of cough sent a 62-year-old woman for medical evaluation. The patient denied fever, chills, and rigors but reported seeing streaks of blood in her sputum during the past month. The patient had undergone a right nephrectomy 4 years earlier for renal cell carcinoma.
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Case In Point: A patient with persistent left superior vena cavaThe authors describe a patient whose persistent left superior vena cava was first suspected because of difficulty in placing a right internal jugular venous catheter.
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Creeping EruptionThe foot of a 10-year-old boy demonstrates the unique wandering cutaneous lesions of creeping eruption, or cutaneous larva migrans. This disorder is caused by skin penetration of hookworm larvae. It is seen in the southeastern United States and tropical and subtropical regions throughout the world.
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Woman With Abdominal Pain and ObstipationA 63-year-old woman presents to the emergency department with a 3-day history of abdominal pain, nausea, and obstipation. The pain is located in the left lower quadrant and is sharp, constant, and nonradiating.
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CollagenomasDuring a skin cancer screening, a 45-year-old male soldier was noted to have bilateral subcutaneous nodules on the dorsa of his feet. The patient reported that the nodules had remained unchanged since they first appeared in his early 20s and were asymptomatic. He had no other lesions.
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Creeping EruptionThe foot of a 10-year-old boy demonstrates the unique wandering cutaneous lesions of creeping eruption, or cutaneous larva migrans. This disorder is caused by skin penetration of hookworm larvae. It is seen in the southeastern United States and tropical and subtropical regions throughout the world.
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Aortic Valve AbscessA 75-year-old woman with a bioprosthetic aortic valve, who had undergone surgical repair of an aortic root aneurysm 9 months earlier was hospitalized with fever, headache, and altered mental status of 1-day's duration.
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SARS: Would You Be Ready?In November 2002, cases of an atypical pneumonia were reported in the Guangdong province of southern China. By the following June, outbreaks of the illness-known as severe acute respiratory syndrome (SARS)-had occurred in Germany, Ireland, the United States, Canada,Hong Kong,Singapore, and Vietnam.
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Ulcerative Colitis With PseudopolypsFor 6 weeks, a 29-year-old previously healthy man had between 10 and 15 episodes daily of small-volume bloody diarrhea with intermittent paraumbilical pain. Anorexia and the loss of 25 lb accompanied the diarrhea. The patient had no significant medical history, took no medications, had not traveled recently, and had no contact with sick persons. He denied fever, chills, nausea, vomiting, and all other symptoms.
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Varicella-Zoster Virus InfectionAre these tender, vesicular erythematous lesions symptomatic of HIV/AIDS? Of Ramsay Hunt syndrome? Of herpes simplex or varicella-zoster virus? What's your diagnosis?
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What caused an elevated diaphragm in this woman with cough and dyspnea?A 52-year-old woman presented to her primary care physician complaining of a nonproductive cough and dyspnea on exertion. These symptoms had a subacute onset over 4 weeks before her initial visit. She denied fever, sputum production, hemoptysis, chest pain, palpitations, abdominal pain, nausea, vomiting, and diarrhea. She did not have any known sick contacts.
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Enoxaparin DermatosisThis is a very distinct, rare, and remarkable hemorrhagic rash, first recognized in 2006, with 7 known cases reported in the literature.
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End-of-Life Discussions: The Art of Delivering Bad NewsAn 84-year-old woman with progressive stenosis of the cervical spinal canal, type 2 diabetes mellitus, hyperlipidemia, gastroesophageal reflux disease, hypertension, and stable angina presents to her primary care physician after an appointment with the orthopedist who is monitoring her chronic degenerative joint disease.
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Woman With Sudden Drop in Platelet CountOn her third day of hospitalization for acute gallstone pancreatitis, a 49-year-old woman's platelet count fell to 113,000/L from 216,000/L the previous day.
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Diagnostic Images, Treatment DecisionsApreviously healthy 22-year-oldHawaiian man presents to theemergency department (ED) of a hospitalin California with a 3-day historyof fever and chills. He has also had aprogressively worsening, persistent,dull aching pain in the right upperquadrant of the abdomen for the pastweek. The pain is localized-with noaggravating or relieving factors-andis not related to meals. The patienthas had no nausea, vomiting, loss ofappetite, jaundice, abdominal distension,cough, chest pain, dyspnea,weight loss, or lymphadenopathy.
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Bronchoscopy Clinic: A patient with "worsening asthma"A 45-year-old man was referred to our pulmonary clinic for progressive dyspnea and worsening asthma. His shortness of breath had been worsening over the past 2 years. He denied fever, weight loss, and other systemic complaints.
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Enoxaparin DermatosisThis is a very distinct, rare, and remarkable hemorrhagic rash, first recognized in 2006, with 7 known cases reported in the literature.
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Suspected UTI in Nursing Home Patients: When to TestIs it appropriate to routinely order urinalysis for patients in a nursing home (both with and without dementia) when they exhibit behavioral changes but show no signs or symptoms of urinary tract infection (UTI)?
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Intrathoracic GoiterA 69-year-old woman was admitted to the hospital with wheezing and dyspnea. She also complained of hoarseness and slight dysphagia that had caused a loss of 12 lb during the past 4 months. The patient had been treated for bronchial asthma as an outpatient, but the worsening episodes of wheezing were not being controlled by bronchodilator therapy.
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Man With Reflux Symptomsand Esophageal Papular LesionsA 51-year-old man with a 12.5-pack-year smoking history had symptomssuggestive of gastroesophageal reflux disease for 6 weeks.
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What Is This Penile Lesion?For 20 years, a lesion has been slowly growing on the penis of a 51-year-old man. He has noted bleeding and a foul-smelling discharge from the mass. Recently, the patient experienced a 30-lb weight loss. He has had 5 sex partners in his lifetime but has been monogamous for the past year.
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Atypical Celiac Disease: Could You Be Missing This Common Problem?For every recognized case of celiac disease, 8 more remain undiagnosed. The reason for this disparity is contingent on the varying presentations of the disease.
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Irrigation: Easy Technique for Difficult LocationsUse a saturated sterile cotton ball whenever you need to irrigate ears or other small, hard-to-reach places.
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Man With Headache, Diplopia, Nausea, and VomitingA 68-year-old man presents to the emergency department with diplopia and headache of acute onset accompanied by nausea and vomiting.
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Mild Traumatic Brain Injury:Traumatic brain injury may occur without visible head injury; it manifests as confusion, focal neurologic abnormalities, an altered level of consciousness, or subtle changes on neuropsychological testing. The initial evaluation includes assessment of the patient's airway and respiratory, circulatory, and neurologic status.
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Case ReportA 49-year-old white man, in whom HIV infection had been newly diagnosed (CD4+ cell count, 25/µL; HIV-1 RNA level, 274,000 copies/mL), was transferred to our hospital for further workup and treatment of multiple neurologic deficits. He had presented to another hospital with a 4-day history of left-sided weakness and numbness, left-sided facial droop, dysphonia, and dysphagia that led to the initial diagnosis of an acute stroke.
