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Consultant Vol 50 No 11

For 5 days, a 68-year-old woman has been bothered by a painful swelling on her left cheek. There is no history of trauma or bite. She takes a diuretic for mild hypertension. Amoxicillin/clavulanate was started 2 days earlier pending the results of a bacterial culture.
What is the likely diagnosis?

Eczema is confined to the dorsum of a 37-year-old
woman’s hands. She had been applying an over-thecounter,
topical antifungal cream but noted no change
in the rash. The patient is a hairdresser and enjoys

A 45-year-old man of Hispanic ancestry presents for evaluation of what he describes as a "growth in both eyes." This growth has been present for some time; however, it has recently become more prominent. The patient has had mild redness and irritation in both eyes, but he denies any change in vision.

Will you recognize these potentially life-threatening infections when you see them? Inside: clues to early diagnosis.

Diabetes is a demanding and difficult chronic disease. Life changes dramatically for a patient and his or her family once the diagnosis is made. Nutritional food choices, increased physical activity, multiple medications, visits to a physician, and blood tests are no longer optional. They now are a means of changing the length and quality of life. The patient has to rapidly become knowledgeable about nutritional content of any food he eats, different ways to be active, blood glucose testing, medication doses and side effects, and new words and abbreviations, such as A1c, LDL, HDL, and triglycerides.

For 3 days, a 28-year-old woman with a history of polymyositis and possible dermatomyositis had fever, chills, and nonproductive cough. She complained of rash, joint pain, and progressive immobility because of severe muscle weakness. For the past 6 years, she had been taking prednisone (60 mg/d), hydroxychloroquine (200 mg bid), and tramadol (100 mg q6h prn for pain).

Elective splenectomy has been scheduled for a 60-year-old man with severe idiopathic thrombocytopenic purpura (ITP) that has responded poorly to treatment. His current platelet count ranges from 5000/μL to 10,000/μL despite several months of aggressive therapy, including 2 courses of high-dose corticosteroids and 2 courses of intravenous immunoglobulin.

Chronic plaque psoriasis in this 37-year-old man was treated with systemic corticosteroids after topical medications proved ineffective. The corticosteroids provided initial relief, but the psoriasis recurred once the medication was discontinued. This patient had been in a county jail for about 18 months; during his confinement, he was not exposed to sunlight.


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