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Consultant Vol 43 No 8

A 59-year-old man, who was unable to walk, was brought to the emergency department with severe leg pain, worsening weakness, increasing fatigue, chills, and fever of 3 days' duration. The symptoms began after a round of golf. In addition to the leg pain, which particularly affected the calf muscles, the lower extremities were red and swollen.

Twenty-four hours after a car accident, a 47-year-old man with chronic low back pain-which had been diagnosed years earlier as "arthritis" of the spine-presented with back and chest pain and requested an opioid analgesic. The patient had a history of alcoholism and illicit drug use. Tenderness of the thoracic area was noted.

For 3 weeks, an extremely painful lesion had been present on the right ankle of a 46-year-old man. The 7 × 6-cm tender erosion was located just superior to the lateral malleolus. An antibiotic prescribed by another practitioner for a presumed infected insect bite had failed to ameliorate the pain and clear the lesion.

This inflammatory myopathy is believed
to be related to immune-mediated
muscle damage. An increased incidence
of malignancy is associated
with dermatomyositis (DM), especially
in patients older than 50 years.

The manifestations of this multisystem
disorder range from relatively
benign, self-limited cutaneous involvement
to severe, potentially fatal systemic
illness. Skin lesions associated
with lupus erythematosus (LE) are
classified histologically as LE-specific
or LE-nonspecific.

For 6 weeks, a 29-year-old previously healthy man had between 10 and 15 episodes daily of small-volume bloody diarrhea with intermittent paraumbilical pain. Anorexia and the loss of 25 lb accompanied the diarrhea. The patient had no significant medical history, took no medications, had not traveled recently, and had no contact with sick persons. He denied fever, chills, nausea, vomiting, and all other symptoms.

At 37 weeks' gestation, a 27-year-old woman (gravida 1, para 0) presented with increasing vaginal pain and a yellowish white discharge of 1 week's duration. Despite use of a topical antifungal prescribed by another practitioner, the symptoms worsened and a vaginal mass suddenly appeared. The patient denied any history of sexually transmitted disease.


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