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The purple-stained urine bags and tubing of 2 elderly patients are shown here. Neither patient received urine-discoloring medications.

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A 50-year-old woman presents to the emergency department with severe dizziness, weakness, and dyspnea of 1 week’s duration. Ten days earlier, an upper respiratory tract infection (URTI) was diagnosed; over-the-counter cough syrup and acetaminophen were prescribed. However, the patient’s condition has steadily deteriorated since then. In addition, her urine has darkened over the past few days.

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An 11-year-old boy presented to the hospital with a 3-day history of maculopapular rash over the face, trunk, and extremities. He had completed a 5-day course of trimethoprim-sulfamethoxazole for otitis media 1 week before presentation. His medical history was otherwise unremarkable. Over the past 3 days, the rash had become pruritic and the lesions progressively larger. Some lesions were vesicular and bullous. There was diffuse involvement of the oral mucosa, conjunctivae, and genitalia.

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This child fell from his bicycle 3 days ago and suffered mild head trauma.He lacerated his forehead and sustained some abrasions and bruises in thesurrounding scalp. His mother now seeks medical care because the child’seyelids have become so swollen that he can hardly open his eyes.

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Postsurgical endophthalmitis caused by Rhizobium radiobacterdeveloped in a 62-year-old man. The patient was treatedwith empiric intraocular therapy. On identifying the causativeorganism, systemic ciprofloxacin was added to the treatmentregimen. Therapy resulted in complete resolution of visualchanges caused by the infection. [Infect Med. 2008;25:274-276]

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Abstract: Because of the impact of allergen exposure on asthma control, all patients with asthma should be evaluated for allergic sensitization. Such patients can be referred to an allergist for evaluation, or radioallergosorbent tests can be ordered by the primary care provider. The major groups of aeroallergens that can trigger asthma attacks include furred-pet, dust mite, cockroach, rodent, mold, and pollen allergens. When assessing a patient's exposure history, remember that furred-pet allergens are found not just in the home, but in other settings, such as schools, and these allergens are passively transferred from one environment to another. Allergen avoidance measures are essential to the management of asthma in sensitized patients and can significantly improve asthma control. First-line dust mite control measures include installing allergen-proof mattress and pillow encasements, washing all bedding every 1 to 2 weeks in hot water, removing stuffed toys, vacuuming and dusting regularly, and reducing indoor relative humidity. (J Respir Dis. 2006;27(12):511-526)

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Microscopic polyangiitis is a potentially fatal disease if it is notrecognized and treated early. In the case described here, what initiallypresented as a postinfectious residual cough was actuallyactive pulmonary hemorrhage, severe anemia, and a crescenticglomerulonephritis. Significant improvement was achieved withhemodialysis and aggressive treatment with corticosteroids andcyclophosphamide. This case exemplifies a classic presentationof microscopic polyangiitis and demonstrates the importance ofan expeditious diagnostic evaluation and early treatment to preventrapid deterioration. Early recognition and highly aggressiveimmunosuppressive treatment achieved significant suppressionof the disease.

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Over the past 15 years in the United States, HIV/AIDS has become increasingly common among women. In 1990, women made up only 11% of the newly reported cases of AIDS.1 In 2006, 27% of newly reported AIDS cases were in women.2

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A 74-year-old woman presented with a refractory pruritic eruption. Four months earlier, she had sought evaluation of a thickened, slightly crusted 6 3 8-cm patch on her right ankle of 2 months' duration. Contact dermatitis with secondary impetigo from scratching was suspected, and a topical corticosteroid and an oral antibiotic were prescribed.

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Bacteremia caused by viridans streptococci frequently presentsin a subacute fashion and can lead to complicated infections.It usually manifests from an oral source and may result inseeding of the heart valves. We describe a case of viridansstreptococci bacteremia that developed after a dental procedureand was complicated by endocarditis and vertebral osteomyelitis.Symptoms and signs that may heighten suspicion forcomplicated bacteremia caused by viridans streptococci arediscussed. [Infect Med. 2008;25:552-555]

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Platelet function monitoring and adjustment of treatment based on results after coronary stenting does not improve clinical outcomes . . . and other findings from the AHA Scientific Sessions.

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The safety profile correlates with lower observed risk of stent thrombosis, according to an analysis of insights from a nationwide coronary intervention registry.

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Four months after coronary artery bypass surgery, a 77-year-old man began to suffer severe pain in his feet. Multiple necrotic areas developed on the toes.

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The patient was a 40-year-old African American woman, with no significant past medical history, who presented to our medical center with a 4-week history of shortness of breath and lower extremity edema. The onset was progressive and initially occurred only with moderate exertion until about 2 weeks before presentation; at that time, her symptoms had worsened to the point where she experienced shortness of breath at rest. Orthopnea also developed at this time. The patient also reported intermittent palpitations, wheezing, and a dry cough of unknown duration.

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The successful management of immunosuppression followingsolid organ transplant requires a delicate balance betweenpreventing allograft rejection and minimizing the risk ofinfection. Strategies that may reduce the risk of de novoopportunistic infection and emergence of latent infectionduring the early posttransplant period-specifically infectioncaused by Cytomegalovirus, opportunistic fungi such as Aspergillus and Candida, and bacteria such as Pneumocystisjiroveci and Mycobacterium tuberculosis-are presented in thisreview. [Infect Med. 2008;25:403-415]

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These grouped, white to flesh-colored papules on the plantar aspect of a 28-year-old woman's heels appeared during weight bearing and disappeared in non–weight-bearing positions. The patient, a nurse whose work required standing for hours, noticed the lesions about a year earlier. Her medical history was unremarkable, and she was taking no medications. Her sister had similar lesions on her heels.

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Mongolian spots are benign, congenital blue-gray macules or patches commonly found in Asian, black, and Hispanic infants (and in 5% of white infants). They are most often located in the sacrogluteal area and the upper back. The lesions may be solitary or multiple, vary in color intensity, and frequently enlarge until about age 2, when they gradually fade and disappear. Approximately 5% persist into adulthood.

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Mongolian spots are benign, congenital blue-gray macules or patches commonly found in Asian, black, and Hispanic infants (and in 5% of white infants). They are most often located in the sacrogluteal area and the upper back. The lesions may be solitary or multiple, vary in color intensity, and frequently enlarge until about age 2, when they gradually fade and disappear. Approximately 5% persist into adulthood.

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Loss of pigmentation was noted around the left eyeof a 49-year-old man-the same eye in which hehad a detached retina. In addition, the patient'shearing was impaired on that side. These findingswere consistent with the diagnosis of Alezzandrinisyndrome, the major manifestations of which includeunilateral degenerative retinitis, ipsilateral facial vitiligo,poliosis of the eyebrows and eyelashes, and ipsilateralhearing deficits.

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Abstract: The management options for persons with obstructive sleep apnea-hypopnea syndrome (OSAHS) include lifestyle changes, continuous positive airway pressure (CPAP), oral appliances, and surgery. Lifestyle modifications work best in persons with mild OSAHS and may include weight loss and cultivation of good sleep habits, such as not sleeping supine. Before initiating CPAP therapy, polysomnography is recommended to determine the best airway pressure for the patient. Although the benefits of CPAP have been well documented, compliance remains an issue; some difficulties may be alleviated through patient/partner education and close follow-up. Oral appliances, which work by mechanically enlarging or stabilizing the upper airway, are preferred by some patients; however, they are less effective than CPAP at reducing the apnea-hypopnea index. Surgical interventions to alleviate upper airway obstruction can be used in select patients. (J Respir Dis. 2006;27(5):222-227)

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A general practitioner can gain a better understanding of a patient’s underlying cardiac ailments by learning the fundamentals.

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A 47-year-old woman presented to the emergency department with chest pain of sudden onset. The patient had no history of coronary artery disease, peptic ulcer, gastroesophageal reflux disease, or similar episodes of chest pain. She had not traveled long distances or suffered trauma or injury recently.

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ABSTRACT: In patients with jaundice and normal liver function, the cause of hyperbilirubinemia is an isolated disorder of bilirubin metabolism. In patients with hyperbilirubinemia who have abnormal liver enzyme levels, hepatocellular disease must be differentiated from cholestatic liver injury. In general, if the cause of jaundice is global hepatocellular dysfunction, the serum alanine aminotransferase and aspartate aminotransferase levels will be predominantly elevated. If the cause is cholestasis, the serum alkaline phosphatase and gγ-glutamyl peptidase levels will be elevated. In most patients, imaging studies will be needed. The initial workup should include abdominal ultrasonography, which can identify dilated intrahepatic and extrahepatic biliary ducts as well as findings that may suggest cirrhosis or signs of portal hypertension, including splenomegaly and ascites.

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Abstract: Allergic drug reactions are mediated by IgE. Other immunologic drug reactions are mediated by IgG and complement, T cells, systemic cytokine release, and mast cell activation. True drug allergies, which are IgE-mediated, account for less than 10% of all adverse drug reactions. IgE-mediated reactions are commonly seen with penicillins, but also occur with some other antibiotics, chemotherapeutic agents, therapeutic proteins, and neuromuscular blockers. They are often limited to urticaria but also include life-threatening anaphylaxis. Skin testing to identify patients who are allergic is available for many agents associated with IgE-mediated reactions. Protocols for desensitization permit the use of some culprit agents when indicated. (J Respir Dis. 2006;27(11):463-471)

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A total of 50 health care professionals, including 25 health plan medical directors, 20 health plan pharmacy directors, and 5 pharmacy directors for pharmacy benefit management companies were surveyed regarding their perceptions of the value of 3 novel cancer therapies. The physicians and pharmacists were asked to estimate the monthly average wholesale price of each therapy, overall survival benefit of bevacizumab for treatment of persons with advanced colorectal cancer and erlotinib for treatment of persons with non–small-cell lung cancer, and progression-free survival benefit of sunitinib malate for treating persons with advanced renal cell carcinoma. Most respondents overestimated drug costs and underestimated survival benefit associated with these treatments. Mean incremental cost-effectiveness ratio for all drugs studied was approximately $170,000/quality-adjusted life-year (QALY). Cost-effectiveness ratios were lower than the $300,000/QALY cited by oncologists in another study but significantly higher than those for many other costly interventions. Our study findings reflect the need for a better understanding of the value of the clinical benefits of novel cancer therapies in an environment of product innovation but with resource constraints. (Drug Benefit Trends. 2009;21:120-130)

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A 38-year-old African American man with HIV infection presents with numerous dyspigmented macules and patches on the extremities, abdomen, and chest; the lesions are smooth, nontender, and minimally pruritic. He has been noncompliant with antiretroviral therapy since his diagnosis 3 years earlier.

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A 38-year-old woman presented with bruising and pain of the lower extremities and dyspnea on exertion. She had had these symptoms for 3 weeks. She denied hematuria, melena, hematemesis, fever, or abdominal pain. Results of routine blood work showed a hemoglobin level of 6.4 g/dL (19 months earlier, this level was 15.8 g/dL).

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This gastrovascular disorder is rare yet life-threatening when it occurs. It is caused primarily by any process that leads to increased acuity of the aortomesenteric angle.

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Superficial adenopathy is the most common symptom ofcatscratch disease (CSD) attributed to Bartonella henselaeinfection. More complicated adenopathy with pulmonaryinvolvement can occur. We report a case of a 15-year-oldboy with pleural symptoms related to B henselae–associatedCSD. [Infect Med. 2008;25:248-250]