April 1st 2025
Family physician and researcher Mark Ebell, MD, discusses the clinical implications, efficacy, and role of gepotidacin in UTI management.
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.
Wheezing in a 52-Year-Old Woman With a History of Colon Cancer
April 1st 2006A 52-year-old woman was admitted tothe hospital with progressive shortnessof breath of 2 days’ duration. Bronchialasthma had been diagnosed 6 monthsearlier; inhaled corticosteroids, bronchodilators,and leukotriene antagonistswere prescribed. Despite aggressivetreatment, the patient’s dyspneaand wheezing worsened.
Delirium in Elderly Patients:How You Can Help
April 1st 2006Delirium in older adults needs to berecognized early and managed as amedical emergency. Prompt detectionand treatment improve both shortandlong-term outcomes.1,2 Becausedelirium represents one of the nonspecificpresentations of illness in elderlypatients, the disorder can be easilyoverlooked or misdiagnosed. Misdiagnosismay occur in up to 80% of cases,but it is less likely with an interdisciplinaryapproach that includes inputfrom physicians, nurses, and familymembers.3
Clinical Citations: Managing pneumonia: Do practice guidelines really help save lives?
April 1st 2006Guidelines for the management of community-acquired pneumonia (CAP) have been published by several medical organizations, including the British Thoracic Society, the American Thoracic Society, and the Infectious Diseases Society of America (IDSA). Do these guidelines help improve survival rates? Yes, according to a study that focused on adherence to the IDSA guidelines and outcomes for patients with severe CAP. This study also underscores the importance of providing adequate coverage for Pseudomonas aeruginosa in patients with risk factors such as chronic obstructive pulmonary disease (COPD), malignancy, or recent antibiotic treatment.
Case In Point: Recognizing allergic bronchopulmonary aspergillosis
April 1st 2006A 28-year-old man presented with chest pain, hemoptysis, and wheezing. He had a history of intermittent shortness of breath that occurred at least 3 times a year in the past 3 years; fever; and loss of appetite associated with headache, vomiting, and weakness. His medical history also included asthma, chronic gastritis, and more than 5 episodes of pneumonia since 1996. A test for hepatitis C virus (HCV) had yielded positive results.
Diagnostic Puzzlers: What caused this patient's chest wall mass?
April 1st 2006A 66-year-old man presented with weight loss for 2 months, loss of appetite for several weeks, and abnormal chest radiographic findings. He denied chest pain, cough, fever, chills, shortness of breath, and chest trauma. He was an active smoker, with a 50-pack-year history of smok- ing, and a cocaine and alcohol abuser. His history included treatment of hypertension for 10 years and treatment of pulmonary tuberculosis 14 years previously.
Clinical Citations: Is there a role for PCR in the evaluation of invasive aspergillosis?
April 1st 2006High-resolution CT (HRCT) and galactomannan enzyme-linked immunosorbent assay (ELISA) are valuable in the diagnosis of invasive aspergillosis; however, both of these methods have limitations. Although the role of polymerase chain reaction (PCR) testing has not been established yet, the results of a study in the Netherlands are encouraging.
Multidrug-resistant tuberculosis: An update on the best regimens
April 1st 2006Abstract: Multidrug-resistant tuberculosis is defined as tuberculosis caused by strains that have documented in vitro resistance to isoniazid and rifampin. Treatment involves a regimen consisting of at least 4 or 5 drugs to which the infecting strain has documented susceptibility. These agents may include ethambutol, pyrazinamide, streptomycin, a fluoroquinolone, ethionamide, prothionamide, cycloserine, and para-aminosalicylic acid. In addition, an injectable agent, such as kanamycin, amikacin, or capreomycin, should be used until negative sputum cultures have been documented for at least 6 months. If the patient has severe parenchymal damage, high-grade resistance, or clinically advanced disease, also consider clofazimine, amoxicillin/clavulanate, or clarithromycin, although there is little evidence supporting their efficacy in this setting. Routine monitoring includes monthly sputum smear and culture testing, monthly assessment of renal function and electrolyte levels, and liver function tests every 3 to 6 months. (J Respir Dis. 2006;27(4):172-182)
Man With Progressive Induration of the Skin and Pruritus
April 1st 2006A disorder similar to scleromyxedema, nephrogenic fibrosing dermatopathy, has been reported in patients receiving renal dialysis. Lichen myxedematosus, an atypical form of papular mucinosis, is not associated with sclerosis and paraproteinemia; however, it may represent an early presentation of scleromyxedema.
Spontaneous Fracture and Migration of a Catheter to the Pulmonary Artery
April 1st 2006A 50-year-old woman with breast cancer presented for follow-up 2 months after undergoing a left mastectomy and chemotherapy through a port catheter implanted in the right subclavian vein. Because venous access had been difficult to achieve, the catheter was left in situ after treatment.