September 3rd 2024
The updated COVID-19 vaccine targets the currently circulating Omicron variant JN.1 strain of SARS-CoV-2.
An Old Woman With a Very Different Purple Toe
June 7th 2010The plantar aspect of this toe shows purple nonuniform darkening that mimicked either a simple traumatic hematoma or the blue toe syndrome. More proximally, however, the solar aspect contained irregular dark-purple dots reminiscent of individual thrombosed venules, and in addition showed discontinuous purple zones more proximally in the part of the ray that lay within the body of the foot and that surely could not be imputed to any possible toe trauma or fracture nor to ischemia in the distribution of any single vessel. No purple area was warm or tender.
Nitrofurantoin Pulmonary Toxicity: A Rare but Serious Complication
June 4th 2010Nitrofurantoin has been widely used for the treatment and prevention of recurrent urinary tract infections since its introduction into clinical practice in 1953. Although it continues to be an effective antibiotic, nitrofurantoin is associated with several adverse effects, including pulmonary toxicity.
Nonarteritic Anterior Ischemic Optic Neuropathy
May 5th 2010A 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.
Dissecting Cellulitis of the Scalp
May 5th 2010For the past 7 years, a 32-year-old African-American man had multiple nonpruritic scalp abscesses. He also reported intermittent fever and joint pain. The abscesses had been drained on many occasions, and he had received several antibiotics, although no organisms had been isolated. Collagen vascular disease, SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), discoid lupus, and cutaneous sarcoid had been ruled out. During the past 7 years, he had been treated with prednisone, methotrexate, and hydroxychloroquine without any response.
Zoster Vaccine After Shingles? When-and Why
May 4th 2010We published a question from John Mosby, MD, who wanted to know why the zoster vaccine had been administered to an older man in an earlier Photoclinic case who had ophthalmic zoster. We also published the response from Dr Tran, which cited the Advisory Committee on Immunization Practices (ACIP) recommendation to administer the vaccine to all patients 60 years or older in whom it is not contraindicated, including those with a history of previous zoster.
Preparing for the “Tsunami of Older Adults”
April 28th 2010Two of the numerous geriatrics offerings at this year’s ACP convention were part of a series entitled “Modifying Your Office Practice for the Tsunami of Older Adults.” This eminently apropos title was actually something of a theme for the convention as a whole. This year, only 3 clinical categories boasted more offerings than geriatrics. Clearly, primary care physicians are beginning to feel the impact of the baby boomers’ coming of age.
Vitamin D Deficiency: Hypothesis or Hype?
April 27th 2010Michael F. Holick, MD, PhD, the Boston University professor of medicine and well-known “apostle of vitamin D,” attracted a standing-room-only crowd Friday for a presentation on his favorite topic. It was a performance that had the audience at rapt attention for a full hour-not just because of the celebrity of the speaker, but because of the extraordinarily clever and engaging nature of his presentation.
Teenaged Girl With a Unilateral Swollen Purple Labium
March 3rd 2010A 13-year-old girl is seen because of a genital injury sustained during a fall from her bicycle. Is post-menarchal. Denies any past or present sexual activity, consensual or coercive. Parents report that she has not been ill-adjusted at school and has had no more behavioral issues than her age cohort in recent months.
Is this asymptomatic penile lesion an HPV infection?
March 3rd 2010For several weeks, a 33-year-old man has had an asymptomatic lesion on the head of the penis. He has had a new sex partner in the past few months but is unaware of any health problems she may have. What is the likely cause of this lesion?
Global Focus: Reports From Physician-Volunteers Around the World
February 19th 2010As a screener and admissions committee member at our medical school (University of California School of Medicine at Davis), I am privileged to review the personal statements of many, many applicants who want to be doctors in spite of the recent hard times in our country that have led more than a few American physicians to believe that our profession is less valued and less desirable as a life work than it has been in the past.
Why Is Zoster Vaccine Needed After Shingles?
February 10th 2010A documented anti–varicella-zoster virus (VZV) titer is generally accepted as evidence of protection against VZV infection, and a known case of shingles, such as that described in the Photoclinic case of an older man with ophthalmic zoster (Tran KT, Qualm AS, Shannon MA. CONSULTANT, December 2009, page 767), might reasonably be expected to boost anti-VZV titers in the affected patient. Why then would administration of the zoster vaccine be included in this patient’s treatment plan?