Bruce Sosler, MD

An 82-year-old woman was admitted to the hospital with severe dilated cardiomyopathy. The condition was alcohol-induced and had been diagnosed about 12 years earlier. The patient was taking angiotensin-converting enzyme inhibitors and diuretics.

A 66-year-old man presented to the emergency department complaining of vomiting “coffee ground” emesis for 3 days. His history revealed chronic alcoholism for the last 30 years.

While evaluating this 26-year-old man for suspected sinusitis, skull films revealed the fragments of a 32-caliber gunshot embedded in his brain. The anteroposterior and lateral radiographs show three metallic bullet fragments; the largest remnant is on the left side of the occipitoparietal region. The patient reported being shot at age 11 but denied any residual neurologic signs.

A 32-year-old Hispanic woman with AIDS presented with a 1-month history of diarrhea; abdominal bloating and cramps; loss of appetite; and pronounced fatigue, malaise, and weight loss. She had no fever or chills and was not vomiting. Her CD4+ cell count was 12/µL. Results of a routine microscopic examination of stool for ova and parasites were negative; an acid-fast stain of stool demonstrated oocytes of Cyclospora cayetanensis measuring 8.8 mm in diameter (pictured, magnification ×1,000). This is about twice the size of the Cryptosporidium parvum oocyte, which typically is 4 to 5 mm.