April 1st 2025
Family physician and researcher Mark Ebell, MD, discusses the clinical implications, efficacy, and role of gepotidacin in UTI management.
Aged Woman With Sudden Striking and Unfamiliar Oral Lesion
February 1st 2009An 89-year-old woman is seen because of a white area on the tongue. She has been hospitalized on a behavioral health unit for 2 weeks; 1 day ago, enoxaparin was begun for a new left leg deep venous thrombosis. Recent antibiotic therapy for a urinary tract infection; candidal vulvitis followed and was treated with topical clotrimazole. Has penicillin allergy.
Fever in a Woman With an Abnormal White Blood Cell Count
January 2nd 2009The patient has a small-fiber sensory neuropathy that is managed with lamotrigine. She is a physical therapy student who has frequent patient contact. She drinks alcohol occasionally but denies smoking and illicit drug use; she says she is not sexually active.
What Treatment for Family Pet When Tot Has Tinea?
January 2nd 2009In his “Dermclinic” discussion of tinea corporis (CONSULTANT, June 2008, page 517), Dr David Kaplan stated that “the family was advised to have their dog examined by a veterinarian because the pet was the suspected source of the dermatophyte.” Examination of the family dog is probably not necessary and can be an expensive recommendation. It is true that ringworm is a zoonotic infection that can be passed to and from both dogs and cats.
Prevention of Recurrent MRSA Skin Infections: What You Need to Know
December 2nd 2008Methicillin-resistant Staphylococcus aureus (MRSA) was once considered a strictly nosocomial pathogen. Over the past decade, however, MRSA has emerged as a prominent cause of community-associated infections in both adults and children. Although community-associated MRSA strains occasionally cause severe invasive infections, they are most frequently isolated from patients with skin and soft tissue infections.
Woman With Severe Headache and Left-Sided Weakness
December 2nd 2008A 47-year-old Hispanic woman with severe headaches of 1 month’s duration presents to the emergency department (ED). The pain encompasses the entire head, is constant and crushing (10 on a scale of 1 to 10), and has progressively worsened.
From Popcorn to Nuts in Diverticulosis: Good-bye to an Old Chestnut
December 2nd 2008A patient comes to her physician for instructions consequent to the discovery of diverticular disease. She is cautioned to avoid high-residue foods, such as nuts, seeds, popcorn, and corn either on or off the cob, because the by-products of these foods might lead to trauma or obstruction at the diverticular opening in the colon, resulting in brisk bleeding or infection.
Headache Secondary to Epidural Abscess
November 2nd 2008Two weeks before admission, he had visited the emergency department (ED) because of the headache. Migraine was diagnosed and ibuprofen had been prescribed. The headache persisted despite NSAID therapy, and the patient returned to the ED 2 days later.
Insect Bite Reaction and Mixed Bacterial Infection
November 2nd 2008This acute pruritic eruption developed on a 49-year-old woman’s thigh after she had been doing yard work. She promptly sought medical attention at the emergency department. Because cellulitis was suspected, she was given ceftriaxone and an oral cephalosporin was prescribed.
Perifolliculitis Abscedens Et Suffodiens
November 2nd 2008For about 10 years, a 26-year-old man had recurring cystic lesions on his scalp that would periodically enlarge, shrink, and occasionally drain. One lesion had been excised by another physician, but it later recurred. The patient had been taking minocycline (100 mg) daily for this condition.
Tonic-Clonic Seizure in a Man With HIV Infection
November 1st 2008A 36-year-old man presents to the emergency department (ED) after a single tonic-clonic seizure. He has a history of numerous male sexual contacts. HIV infection was diagnosed 5 months earlier. At that time his CD4+ cell count was 66/μL and his HIV RNA level was 20,000 copies/mL.
Aphthous Ulcer Treatments: Readers Weigh In
October 2nd 2008Several readers wrote in response to Dr Andres Pinto’s “Consultations & Comments” answer to a question about treatment options for a patient with severe aphthous ulcers (CONSULTANT, May 2008, page 411). The additional treatments suggested by these readers appear below, along with Dr Pinto’s comments.
Paroxysmal Events: Differentiating Epileptic Seizures From Nonepileptic Spells
October 2nd 2008It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Patients with sudden flailing movements or unresponsive staring may, in fact, be experiencing psychogenic events. Other types of pathological spells, such as syncope and migraine, can also be mistaken for epileptic seizures.
Regional Folliculitis After Smallpox Vaccination
October 1st 2008For a week, a 36-year-old Marine had clusters of localized papular lesions on the right forearm; he had no systemic symptoms. The patient had been inoculated 20 days earlier in the United States with the vaccinia virus (smallpox vaccine) to the ipsilateral shoulder just before deployment. He had no history of eczema, psoriasis, or drug allergies.
Anaphylaxis: Commonsense Ways to Reduce Risk
September 2nd 2008The term “anaphylaxis” (without protection) was first coined by Richet and Portier in 1902 to describe a “supersensitivity” reaction they observed while attempting to produce tolerance to sea anemone venom in dogs. During their experiments, an unforeseen event occurred.
Boy With Extraordinarily High Blood Lead Levels
September 1st 2008A 9-year-old asymptomatic boy was referred to our tertiary care facility with a blood lead level (BLL) of 59 μg/dL. A diagnosis of attention deficit hyperactivity disorder, which was managed with amphetamine/dextroamphetamine, had been made when the patient was 6 years old.
Spondyloarthropathies: Update on Diagnosis and Therapy
August 2nd 2008Together the spondyloarthropathies form a group of overlapping chronic inflammatory rheumatologic diseases that show a predilection for involvement of the axial skeleton, entheses (bony insertions of = ligaments and tendons), and peripheral joints. They also may involve extraskeletal structures, especially the eyes, lungs, skin, and GI tract.
Serratia marcescens Pneumonia in an HIV-Infected Patient
August 2nd 2008For 3 days, a 45-year-old woman with HIV infection who was noncompliant with her antiretroviral medications had cough, yellowish sputum, fever, and dyspnea. She denied hemoptysis, weight loss, or recent hospitalization. She had a long history of heavy smoking and alcohol and intravenous drug abuse.