September 3rd 2024
The updated COVID-19 vaccine targets the currently circulating Omicron variant JN.1 strain of SARS-CoV-2.
Young Woman With Back, Abdominal, and Shoulder Pain After Assault
May 1st 2006A 1-year-old woman comes to theemergency department (ED) 3hours after a male friend punched herin the left lower back. The blowknocked her to the floor and madeher feel faint. She also noticed bloodin her urine when she voided athome after the injury.
Case In Point: Coexisting Hodgkin disease and lung cancer in a patient with AIDS
May 1st 2006The patient was a 41-year-old manwith a history of HIV infection diagnosed10 years before admission.He had been noncompliant withtreatment, and therapy with tenofovir,efavirenz, and lamivudinehad not been started until 2 monthsbefore admission, when he presentedto another hospital. At thetime, his CD4+ cell count was156/µL and his viral load was45,743 copies/mL. He also had ahistory of incarceration; had usedinjection drugs, cocaine, alcohol,and marijuana; and had a 20-packyeartobacco history.
Young Man With Chest Pain, Headache, and Muscle and Joint Pain
May 1st 2006Which test--antistreptolysin O titers, coronary angiography, enzyme-linked immunosorbent assay (ELISA), Western blot testing for Borrelia burgdorferi, or genetic testing for long QT syndrome--would help you diagnose a young man with worsening chest pain, frontal headache, and diffuse muscle and joint pain?
What's Wrong With This Picture?
April 15th 2006A 24-year-old woman presents tothe emergency department withincreasing left lower quadrant pain,nausea, and persistent retching andvomiting of 48 hours’ duration. Thepain ranges from dull and aching tocramping; it has become generalized,and there is no specific relieving factor.During the last 12 hours, she hasalso had fever and chills. She has nourinary symptoms, hematemesis,melena, diarrhea, constipation, or abdominaldistention.
Coping With Postherpetic Neuralgia
April 15th 2006A 79-year-old woman with a 37-year history of type 2 diabetes mellitus complains of head pain that began more thana month ago and is localized to the left frontotemporal region. She characterizes the pain as constant and burning, with minimalfluctuations in intensity. The pain does not increase with any particular activity but is quite disabling; it has causedemotional lability and insomnia. She denies nausea, visual disturbances, weakness of the extremities, dizziness, or tinnitus.Her appetite is depressed; she has experienced some weight loss.
Photo Essay: Clinical Consequences of Toxic Exposure
April 15th 2006The line on the gums of this 30-year-old man indicates lead poisoning. The patient had been employed for 8 months at a lead smelting plant in which no occupational safety precautions had been enforced. He was admitted to the hospital with the classic symptoms and signs of lead poisoning--pain in the nape of the neck that radiated down the spine, posterior thighs, and calves to the plantar aspect of the feet; colicky panabdominal pain; anorexia; weight loss; nausea; vomiting; constipation; bone and muscle tenderness; hyperesthesia of all extremities; insomnia; irritability; generalized weakness; malaise; and dizziness.
DERMCLINIC: A Photo Quiz to Hone Dermatologic Skills
April 15th 2006For 2 months, a 35-year-old woman has been troubled by a bilateral pruritic eruption on her neck. The condition did not respond to a 3-week course of oral terbinafine. The patient has a history of childhood asthma; her only current medication is an oral contraceptive. She has had a cat for the past 2 years. She has not used any new shampoos or conditioners.
Mycobacterium fortuitum Infection
April 15th 2006A 35-year-old veterinary technician who lived in south central Texas presented with a raised, warm, tender 2- to 3-cm papule on her lower leg of more than 2 weeks' duration. Topical mupirocin and oral trimethoprim/ sulfamethoxazole were prescribed, but the papule continued to enlarge and became increasingly erythematous and painful.
Man With Hepatitis C Infection: Making Treatment Decisions
April 2nd 2006Infection with hepatitis C virus (HCV) was recently diagnosedin a 45-year-old man when a positive enzyme-linked immunosorbentassay was followed by a polymerase chain reaction assaythat showed a viral load of 835,000 copies/mL. The patient probablyacquired the infection when he was using intravenous heroin, a practice he quit 10 yearsago. The patient is immune to both hepatitis A and hepatitis B viruses, and there is no coinfectionwith HIV. Liver biopsy shows moderate cellular inflammation (grade 3) and bridging fibrosis(stage 3) but no evidence of cirrhosis. Iron staining shows no abnormal iron deposition in theliver. The HCV genotype is 1A.
Fournier Gangrene In a Man with Type 2 Diabetes
April 1st 2006A 56-year-old man who has type 2 diabetes presents with feverof 3 to 4 days’ duration, scrotal swelling, and a feculent odor. He has nohistory of trauma or serious illness; however, his glucose level has not beenwell controlled during the past several weeks.