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Rendu-Osler-Weber SyndromeA 62-year-old man was admitted to the hospital with iron deficiency anemia, as demonstrated by low serum iron and ferritin levels and high total iron–binding capacity. He had had this condition for at least the last 5 years and had been treated with ferrous sulfate sporadically. The history coupled with the laboratory findings and the telangiectatic lesions on his lower lip led to a diagnosis of hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber disease.
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Atrial Myxoma That Mimics Mitral StenosisFor 2 years, a 60-year-old woman with long-standing hypertension had experienced worsening dizzy spells, fatigue, and chest discomfort. She also had cold extremities, significant dyspnea on exertion, and orthopnea. The patient was taking amlodipine and furosemide.
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OnychogryphosisThis patient, a woman, presented with onychogryphosis, a severe nail change seen on the toes, especially the great toe. Thickening and hardening of the nail substance with a curved growth pattern produces this abnormal clawlike configuration.
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Nonarteritic Anterior Ischemic Optic NeuropathyA 43-year-old white man presented to the emergency department with dyspnea, abdominal bloating, fever with chills, night sweats, decreased oral intake, and myalgia of 1 week's duration. He was found to have heart failure caused by systolic dysfunction. Viral myocarditis was the presumptive diagnosis after investigation for other causes.
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Pulmonary Arteriovenous MalformationA 47-year-old woman presented to the emergency department with chest pain of sudden onset. The patient had no history of coronary artery disease, peptic ulcer, gastroesophageal reflux disease, or similar episodes of chest pain. She had not traveled long distances or suffered trauma or injury recently.
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Infective Endocarditis:An update on developments in infective endocarditis by addressing a number of questions physicians commonly raise concerning prophylaxis, diagnosis, and management.
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Avulsion of the Ischial TuberosityA 13-year-old girl felt a “pop” while doing a split during gymnastics. She later complained of right hip pain and inability to bear weight on the right leg.
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Jellyfish StingWhile scuba diving in the Philippines, a healthy 36-year-old man noticed a red rash on his wrists and dorsa of both hands after he surfaced from a dive. Within a couple of hours, the rash had become painful, swollen, itchy, and papular.
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What caused this woman’s pneumomediastinum?A 35-year-old woman presented to the emergency department (ED) with vague abdominal complaints. The patient had a complex medical history that included diverticulosis and relapsing polychondritis. Initially, her polychondritis was limited to involvement of the ears and nose. Within the past few years, however, her polychondritis flares had been associated with progressive dyspnea, which prompted intermittent and then long-term use of high-dose oral corticosteroids.
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Urinary Incontinence:Choices in Medical Therapy for the Overactive BladderUrge incontinence, also referred to as overactive bladder (OAB)-wet, is the involuntary loss of urine accompanied by or immediately preceded by a sensation of urgency. It has a reported overall prevalence of 16.0% in men and 16.9% in women. Currently, the mainstay of management for symptomatic urgency and OAB-wet is medical therapy.
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Chronic Plaque PsoriasisChronic plaque psoriasis in this 37-year-old man was treated with systemic corticosteroids after topical medications proved ineffective. The corticosteroids provided initial relief, but the psoriasis recurred once the medication was discontinued. This patient had been in a county jail for about 18 months; during his confinement, he was not exposed to sunlight.
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Case In Point: Unilateral agenesis of the diaphragmUnilateral agenesis of the hemidiaphragm is a very rare congenital anomaly. We present the case of an adult who was evaluated for persistent cough. Unilateral agenesis of the diaphragm was an unexpected finding on a chest radiograph.
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A Risk-Based Approach to the Care of Survivors of Childhood Cancer: 3 Case StudiesSurvivors of childhood cancer frequently present to primary care practitioners for a routine physical examination or for urgent care. Knowledge of the patient's cancer history and of the specifics of the treatment are essential to providing proper care and addressing his or her unique risks.
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Disseminated HistoplasmosisA 38-year-old man had fever and fatigue for the past 6 days and tenderness in the left upper abdominal quadrant for the past 3 days. He also had a facial butterfly rash that had been present for 10 years and a 1-year history of lupus nephritis, treated with prednisone and mycophenolate. He denied respiratory complaints or recent weight loss.
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Catheter-Related Rhodococcus Infection in a Woman With Chronic PancreatitisRhodococcus equi is an emerging human pathogen. It is mostfrequently associated with pulmonary infections; however,manifestations may be protean. It can be easily mistaken fora diptheroid-like contaminant or a mycobacterium. Therefore,a high suspicion of R equi infection and specialized testing areencouraged. Vancomycin-based therapy is recommended.Because human infection with this organism is uncommon,thorough reporting will help identify further characteristicsof infection and will help in devising treatment guidelines.[Infect Med. 2008;25:391-393
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Epidermoid Cysts Treated With Phosphatidylcholine InjectionsEpidermoid cysts may be treated with intralesional injections of phosphatidylcholine to avoid potential recurrence, eliminate scarring, and reduce cost.
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Diffuse Gastric PolyposisPersistent bloating, epigastric discomfort, and increased gastric acidity prompted a 47-year-old woman to seek medical care. Gastroesophageal reflux disease was diagnosed; antacids and H2-blockers were prescribed but provided no relief.
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A covert cause of hypoxemia: Intravascular pulmonary lymphomaWe describe a patient with intravascularpulmonary lymphomawho presented withprogressive dyspnea and hypoxemiawith normal chest radiographicfindings. After anunrevealing noninvasive evaluation,a high-grade B-cellintravascular lymphoma wasdiagnosed by bronchoscopywith transbronchial biopsy.Treatment with a modifiedCHOP regimen resulted in resolutionof the patient’s hypoxemiaand exercise limitation.Although intravascular pulmonarylymphoma rarely presentswith pulmonary symptoms,it should be consideredin the differential diagnosis ofpatients presenting with hypoxemiaand normal chest radiographicfindings.
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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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Apical Ballooning SyndromeAfter a family argument, an 83-year-old woman experienced chest pain, a "racing heart," and a choking sensation and was brought to the emergency department. The chest pain lasted 10 to 15 minutes; was sharp, substernal, and nonradiating; and was associated with dyspnea and a bout of emesis. A sublingual nitroglycerin tablet partially alleviated the pain, but the patient felt syncopal. Her symptoms persisted despite the administration of supplemental oxygen and a second sublingual nitroglycerin tablet. The patient had a history of gastroesophageal reflux disease, allergic rhinitis, and osteoarthritis. Her oral medications included esomeprazole (40 mg/d), aspirin (81 mg/d), and fluticasone nasal spray. She had discontinued valdecoxib 3 weeks earlier.
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Another Non-Melanoma Skin Cancer?This mobile tender nodule was discovered on the left wrist of a 60-year-old woman with a history of many non-melanoma skin cancers. What’s your best diagnostic guess?
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Top 5 Seizure and Epilepsy Apps for Primary CareA first aid guide for caregivers, an app that allows patients to track epilepsy trends, and 3 more top epilepsy and seizure apps for primary care.
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Autosomal Dominant Polycystic Kidney Disease in a 38-Year-Old WomanAutosomal dominant polycystic kidney disease (ADPKD) is common. Presenting symtpoms include hypertension, hematuria, proteinuria, and renal insufficiency.
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Silent Myocardial Ischemia: Diagnosis, Treatment, and PrognosisSilent myocardial ischemia (SMI)- objective documented ischemia in the absence of chest discomfort or other anginal equivalents-is a major component of the total ischemic burden for patients with ischemic heart disease.1 In the United States, an estimated 2 to 3 million persons with stable coronary artery disease (CAD) have evidence of silent ischemia. 2
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Wheezing Secondary to Obstructing Endobronchial TumorWith a 1-year history of episodic wheezing, a 62-year-old woman (a smoker for the past 30 years) was being treated for bronchial asthma, but bronchodilator therapy did not control her symptoms. She was hospitalized with worsening dyspnea and a 4.5-kg (10-lb) weight loss over the past 3 months. There was no hemoptysis.
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Pulmonary arterial hypertension: Classification, diagnosis, and prognosisAbstract: Our understanding of the pathobiology of pulmonary arterial hypertension (PAH) has evolved considerably over the past 2 decades, with increasing recognition of the important role that aberrant vasoproliferative responses play in conjunction with disordered vasoconstriction. Classification of the many forms of PAH into categories sharing a similar pathophysiology and clinical presentations help the practicing clinician approach a complex differential diagnosis. Noninvasive tests can be used to narrow this differential but must be applied with an appreciation for their limitations. Transthoracic echocardiography is the screening tool of choice; the workup should also include chest radiography and electrocardiography. However, right heart catheterization is ultimately required to establish the diagnosis. While PAH remains a progressive and generally fatal disease, existing therapies have a significant impact on survival and new therapeutic targets offer great hope for improving the prognosis. (J Respir Dis. 2006;27(11):487-493)
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Plasmacytoma of the BoneA 55-year-old man complaining of backache had localized tenderness at the paraspinal region over the posterior portion of the right 7th rib. A CT scan of the thorax revealed erosion of this portion of the rib, along with a space-occupying lesion that displaced the adjacent pleura and lung. Needle aspiration and biopsy study of this mass showed it to be a plasmacytoma.
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An Unusual Injury to the MouthA 2-year-old boy was brought to the emergency department by his mother after he slipped and fell in the bathtub. The boy's father, who had been bathing the child when the injury occurred, reported that he had briefly turned his back while the child was attempting to drink from the hook-shaped faucet. The child had jerked his head upward when he fell, thus causing the sharp edge of the faucet tip to lodge in the soft floor of the mouth beneath the tongue. The father, in desperation, wrenched the faucet from its base and then was able to remove the tip from the child's mouth. During the removal process, the child reached up and also cut his finger on the sharp edge of the faucet.
