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For 2 weeks, a 60-year-old man had severe nausea and vomiting. Two years earlier, he had had a cholangiocarcinoma, which was treated with palliative cholecystectomy followed by a course of rebeccamycin, an investigational chemotherapeutic agent.

Gastric Outlet Obstruction Following Treatment for Cholangiocarcinoma

Gastric Outlet Obstruction in a 60-Year-Old Man

A 13-year-old girl with known eczema presents with a vesicular rash on her palms that appeared after swimming in the ocean. Skin is tender; vesicles ooze clear liquid. Treated with triamcinolone w/o effect. Watch real-time examination on video.

A. Acute palmoplantar eczema (dyshidrotic eczema)

VIDEO: The child's hands are chronically dry but the skin has recently begun to crack; vesicular rash appeared after an ocean swim. Dx?

Clinical Topics

A 13-year-old Girl with a Vesicular Rash on Palms 

An 8-year-old boy presents with facial swelling of 4 days’ duration. For several months he has had fatigue and leg pain and has had rapid, unexplained weight gain. Generalized edema is noted. Vital signs are: temperature: 98°F; heart rate,110 beats/min; blood pressure, 150/115 mm Hg. Watch the video interview for more signs and symptoms.

Four days of facial swelling was preceded by several months of fatigue, leg pain, rapid weight gain. Watch the video exam for more clues to Dx. 

An 8-year-old Boy with Acute Facial Swelling 


These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite.

These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite. What creature did the biting?

Swollen Hands-What’s Biting?

A 50-year-old woman presented with this ulcerative lesion which she said began approximately one month ago as a small “boil” in the center of the now-enlarged area. She squeezed the initial lesion and treated it with topical antibiotic ointment. The lesion progressively expanded and became extremely painful.

B. Cutaneous manifestation of systemic lupus erythematosus

The rapidly expanding lesion began as a small boil in the center of the ulcerated area 4 weeks ago. What underlying process do you suspect? 

Ulcer with an Undermined Edge 

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

What's This "Red Spot"?

A 9-year-old boy presented with a 1-week history of pruritus and rash on his elbows, knees, back, and legs. Several areas of excoriation were noted. He had recently run through a field of tall grass but denied any other exposure history.

A 9-year-old boy presented with a 1-week history of pruritus and rash on his elbows, knees, back, and legs. He had recently run through a field of tall grass but denied any other exposure history. Your Dx?

What Cause of This Itchy Rash?

John C. Rhee, MD

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