Infectious Disease

In the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: "The future of the general practice of medicine, if any." The year was 1969.

A 69-year-old man with stage II chronic kidney disease due to hypertension fell from his bicycle and presented to the emergency department (ED) with abrasions, ecchymoses, and a 3-cm laceration on his right leg. The patient was an avid cyclist. His wounds were cleaned and the laceration sutured. There were no fractures, and the patient was discharged home.

What are the most significant health risks associated with tattoos?

A 48-year-old woman sought medical attention after an episode of gross hematuria associated with mild right-sided loin discomfort. She did not have urinary frequency, urgency, or dysuria. Her history included 3 urinary tract infections; a Proteus species was cultured on each occasion. The family history was unremarkable. Other than mild loin tenderness, physical findings were normal.

A step-by-step review of various wound closure techniques, illustrated with a wealth of instructive clinical photographs.

This year's influenza season is approaching fast. Although the World Health Organization officially declared an end to the 2009 H1N1 influenza pandemic in August, the H1N1 virus is still circulating and is likely to continue to cause serious disease in infants, young children, pregnant women, and other high-risk groups.

Many patients with a viral upper respiratory tract infection still expect an antibiotic prescription when they come to the office.

For a few weeks, a 36-year-old woman has had this pruritic labial rash.

My patient is a woman in her late 30s who has several episodes a month of confluent facial erythema that is very warm to the touch and highly pruritic.

This year’s influenza season is approaching fast. Although the World Health Organization officially declared an end to the 2009 H1N1 influenza pandemic in August, the H1N1 virus is still circulating and is likely to continue to cause serious disease in infants, young children, pregnant women, and other high-risk groups.

A51-year-old man who was an active injection drug user was admitted to the ICU with septic shock and severe respiratory distress. Notable findings were fever, multiple opacities on a chest radiograph, and an elevated white blood cell count.

This 40-year-old man presented with fever and a generalized, painful, nonpruritic rash of 2 days’ duration. The rash first appeared on his face then spread to his hands, buttocks, and lower extremities. Two weeks earlier, he had an episode of severe rhinitis followed by high fevers, chills, muscle aches, and ankle pain.

Dr Rosen invites you to match the clinical characteristics in the checklist with the disorders pictured in the photos. This month’s challenge: 2 leg lesions.

Inside: a photo guide to the various manifestations of stasis dermatitis, irritant contact dermatitis, and allergic contact dermatitis-including diagnostic clues and treatment options.

A previously healthy 19-year-old woman presents with a sore throat that has become progressively more painful over the course of 1 week. She also has left-sided neck swelling, light-headedness, and intermittent headaches. She denies recent sexual activity.

A 32-year-old woman presents for evaluation of itching in the pubic area.

A linear, severely pruritic rash erupted on the lateral and plantar aspects of the left foot of a 72-year-old woman who had recently been camping on a Caribbean beach. Antihistamines and locally applied antifungal agents offered no relief.

An 18-year-old woman from Mexico was hospitalized because of severe headache with nausea and vomiting. Her headaches had started 4 years earlier and had progressively worsened. They occurred mainly in the occipital region and were pulsating, worse on bending down, and unrelieved by any medication. They were often accompanied by dizziness and presyncope.

A 29-year-old Ukrainian man presents with a mildly pruritic generalized rash, which started 4 days earlier as a widespread eruption. The patient has no contacts who have a similar rash.

During a routine checkup, a 14-year-old girl inquires about a large red spot on her right ankle. The asymptomatic, erythematous area overlying the malleolus has been present for several months.

In adults who present with persistent cough following an upper respiratory tract infection but who have no history of asthma or chronic obstructive pulmonary disease, lung findings are usually “normal” on auscultation.

A 71-year-old African American man presented to the emergency department (ED) with chest pain, dyspnea, and hemoptysis. He had had a few ED visits for similar symptoms within the previous 4 weeks.

How effective is antibiotic therapy for long-standing reactive arthritis?

Here Dr Scheinfeld provides a pictorial guide to neurotic excoriation, perforating folliculitis, chondrodermatitis nodularis chronica helicis, hyperkeratosis, and intertrigo.

A universal vaccine that protects against all strains of influenza virus may eventually replace yearly seasonal flu shots. This vaccine has been shown to be effective in animals, report investigators from the National Institute of Allergy and Infectious Diseases (NIAID).

For 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.

The patient has a history of hospital admissions for complications of alcoholism, including pancreatitis and trauma from falls. What's your diagnosis?

An obese 60-year-old woman presents with a chronic malodorous, itchy rash in her groin.

A 65-year-old man, who was lost to follow-up after abdominal-perineal resection for rectal adenocarcinoma 9 months earlier, presents with progressively worsening neurological symptoms, including bilateral hearing loss, dizziness, gait disturbance, ataxia, and blindness in the right eye.

For 2 days, a 54-year-old woman had an asymptomatic red patch on the left anterior distal lower extremity. In the center of the lesion was an erosion where a flaccid blister had broken. She had experienced 2 previous episodes in which an identical lesion had appeared in the same location. These episodes had been preceded by a urinary tract infection for which she received trimethoprim/sulfamethoxazole.