Maged Ghaly, MD

An 80-year-old woman presented with recurrent abdominal pain for 1 month, constipation, and vomiting. She had no diarrhea, rectal bleeding, or weight loss.

A 70-year-old woman with a history of ischemic heart disease was hospitalized because of generalized weakness, fatigue, and retrosternal chest pain on mild exertion. Her skin was pallid. Chest and heart evaluations were normal, and mild hepatosplenomegaly was discerned.

A 55-year-old woman with no significant medical history reported that diffuse erythematous, patchy, purpuric skin lesions over most of her body had been present for the past year. Applications of an over-the-counter corticosteroid cream helped control the pruritus but did not clear the skin lesions.

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 47-year-old woman complained of pain and swelling of the right knee of 3 days' duration. Positive fullness of the popliteal area with no pulsations was discerned. Doppler ultrasound showed a 2.5 cm × 1.5 cm cystic structure in the right popliteal region; this confirmed the diagnosis of a Baker's cyst.

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.