Abdul M. Swied, MD


Metastatic Melanoma in an 83-year-old Man

An 83-year-old man with a history of hypertension and coronary artery disease presented with a 4-day history of mental status changes, slurred speech, and difficulty ambulating. He reported a lack of appetite and weakness of several days.

Abdul Qazizada, MD


Visual Hallucination: Charles Bonnet Syndrome

Charles Bonnet syndrome is an uncommon condition causing visual hallucination in patients who do not have mental illness

Abdullah Altaych, MD


Inflammatory Breast Cancer

A 40-year-old woman was concerned about an area of redness and tenderness on her left breast. Despite antibiotic therapy prescribed by another physician, the rash had progressed during the past month to erythema and nodules that involved the anterior chest and right breast.

Abed Itani, MD


Chylothorax After Debridement of Necrotizing Fasciitis

A 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever.

Abhineet Sayal, MD


A case of progressive shortness of breath in a patient with emphysema

A 71-year-old man who had received a diagnosis of emphysema 12 years ago was referred by his primary care physician to the pulmonary clinic. His symptoms were well controlled until a few months ago, when he complained of mild shortness of breath on physical activity. However, the shortness of breath worsened and became a significant limiting factor. He also had a persistent dry cough.

Abigail Chandler, MD


MAC Infection in a Man With Pectus Excavatum

For 6 weeks, a 56-year-old man had worsening dyspnea on exertion and a cough productive of yellow sputum with scant hemoptysis. He reported subjective fever over the past month but no weight loss.

Abu Khan, MD


Removing Fishhook From Finger

A 3-year-old boy was at home with his cousin who was preparing for a fishing trip when a fishhook accidentally became lodged in the distal part of the child's right middle finger. There was mild erythema and swelling, with tenderness on palpation. No bleeding or discharge was noted. The patient had full range of motion, with normal sensation and capillary refill. Remaining examination findings were unremarkable. Radiographic views of the affected area confirmed the absence of bony infiltration.

Achal Dhupa, MD


Disseminated Candidiasis

A 72-year-old morbidly obese man who had diabetes mellitus was admitted to the hospital from a nursing home with a fever of 4 days' duration. A tracheostomy had been performed 3 months earlier for respiratory failure. The patient was being treated with corticosteroids for chronic obstructive pulmonary disease.

Adam Friedman, MD, FAAD


Eczema Herpeticum in a 4-Year-Old Girl

This diagnosis is a relative dermatologic emergency; presumptive treatment with antivirals should at least be considered if any suspicion exists.

Adam J. Ash, DO


Lisfranc Ligamental Injury

After a fall during a soccer match 2 weeks earlier, a 26-year-old woman had pain of the right midfoot, with moderate swelling. The pain was aggravated with a normal gait and alleviated with an antalgic gait, specifically with inversion of the right ankle such that most of the weight from heel-strike through toe-off transmitted forces from the lateral calcaneus through the fifth metatarsus to the fifth phalanx.

Adam M. Rubin, MD


Middle-aged Hiker With Facial Paralysis

A 46-year-old man presents with right-sided facial paralysis. His symptoms beganthe previous evening when he had difficulty in closing his right eye; by morning,paralysis had developed. He also reports headache and mild photophobia.

Adam Rubin, MD


Elderly Man With Weakness, Poor Appetite, and Abdominal Cramping on Defecation

An 83-year-old man complains of weakness, easy fatigability, and poor appetitethat began 4 to 6 weeks ago. He becomes short of breath on his daily walksand has lost about 20 pounds over the last 3 months. He denies nocturia,paroxysmal nocturnal dyspnea, exertional chest pain, fever, cough, melena,and hematochezia. His only GI symptom is occasional crampy abdominal painwith bowel movements.

Adeel Khan, MD


A Young Woman With Sudden Loss of Vision in One Eye

A 17-year-old sexually active young woman presented with sudden loss of vision in the left eye 2 weeks before presentation.

Adel Y. Daas, MD


Chilaiditi Syndrome

Dull, intermittent, midepigastric abdominal pain of 1 day's duration prompted a 73-year-old man to seek medical attention. He had no other symptoms.

Adela Spalter, MD


Swallowed Toothbrush in a Bulimic Adolescent

A 16-year-old girl of normal weight for height (body mass index, 21) was evaluated for a 6-month history of binge-purge cycles and amenorrhea. She met the diagnostic criteria for bulimia nervosa and began treatment that involved a multidisciplinary team. During the second month of therapy, the patient presented to the emergency department after she accidentally swallowed a toothbrush while trying to induce vomiting with the brush’s handle.

Aditya Gupta, MD


Case In Point: A man with renal failure, dyspnea, and an apparent lung mass

A 54-year-old man with chronic renal insufficiency presented with shortness of breath, nonproductive cough, and chest pain. The patient had hypertension, type 2 diabetes mellitus, and a 30-pack-year history of cigarette smoking. He denied alcohol or illicit drug use and prolonged exposure to asbestos, chemicals, or fumes.

Adnan Muhammad, MD


An Unusual Presentation of Septic Hip

Emphysematous cholecystitis is a rare condition that is the result of infection with Clostridium perfringens and other gas-producing organisms including Escherichia coli, Bacteroides fragilis, and Klebsiella species.

Adrienne Freidl, MD


Fracture After Fall in a Middle-Aged African American Woman

A 58-year-old African American woman comes for a follow-up visit after sustaining a fracture of the right radius, which occurred when she tripped on loose carpeting and broke her fall with an outstretched hand.

Adwait Silwal, MD


Hematemesis Secondary to a Bronchogenic Cyst

A 24-year-old man with an unremarkable medical history presented to the emergency department with abdominal pain and hematemesis of 3 days' duration. His symptoms were postprandial, and each episode yielded up to half a cup of blood without clots. He denied using NSAIDs or alcohol. He had had an episode of hematemesis 2 years earlier that resolved spontaneously, for which he had not sought treatment. His vital signs were normal, and his physical examination was notable only for moderate epigastric tenderness without rebound or guarding.

Afshin Asgarian Nahavandi, MD


Infection of the Cutaneous Apocrine Glands

Hidradenitis suppurativa is a chronic acneiform infection of the cutaneous apocrine glands.

Againdra Bewtra, MD


COX-2 Inhibitor–Induced Rash

A 63-year-old man was given oral celecoxib, 100 mg bid, for shoulder pain. Three days later, a pruritic rash appeared on his back, then spread to the chest, lower legs, and face. He stopped the celecoxib on his own and self-administered diphenhydramine for the pruritus. The rash and itch persisted, which prompted the patient to seek medical care. He had no respiratory symptoms.

Ahdi Amer, MD


A Rash of Rough Spinous Patches on a Young Girl

The rash has been present for 2 years. Originally on the trunk and extremities it has now spread to her face and hands. She has been diagnosed as having and been unsuccessfully treated for nummular eczema and tinea corporis. What's your Dx?

Ahmad Hakemi, MD


Fifth Disease

The parents of a 2-year-old sought treatment for a rash on their son's face. The child had had a low-grade fever for 3 days before the rash erupted. An intermittent lace-like rash was beginning to develop on the extremities. The patient was otherwise asymptomatic.

Ahmadreza Karimianpour, BSc


Takotsubo Syndrome in an African American Woman With Typical Presentation

Also known as “broken-heart syndrome,” Takotsubo syndrome is a stress-induced cardiomyopathy.

Ahmed S. Bahammam, MD


Might Obstructive Sleep Apnea Explain Your Patient’s Nightmares?

Consider OSA in your the differential diagnosis in patients who present with nightmarers. Continuous positive airway pressure (CPAP) can provide effective treatment.

Ahuti Desai, MD


Nonspecific symptoms are among the obstacles to diagnosis Pulmonary alveolar proteinosis: An easy-to-miss diagnosis key words: Alveolar proteinosis, Surfactant, Whole lung lavage

abstract: Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoproteinaceous material in the alveoli. The most common symptoms are dyspnea on exertion and nonproductive cough. Weight loss, fatigue, chest pain, and hemoptysis have also been reported. Chest radiographs typically show bilateral, symmetrical airspace disease with an ill-defined nodular or confluent pattern, which gives a "bat wing" appearance, as is seen in heart failure. Pulmonary function tests usually demonstrate mild restrictive disease. Findings on examination of sputum specimens or bronchoalveolar lavage fluid can suggest the diagnosis; however, open lung biopsy is the diagnostic gold standard. Whole lung lavage remains the standard of care for PAP and is warranted in patients with severe dyspnea and hypoxemia. Subcutaneous human recombinant granulocyte-macrophage colony-stimulating factor appears to be a promising alternative to whole lung lavage for symptomatic patients. (J Respir Dis. 2007;28(5):177-184)

Ahuva Cices


Shiny Pink Nodule on Malar Cheek

A 68-year-old woman presents with a new 6-mm nodule with central ulceration and a rolled border on the right cheek. What's your diagnosis? How would you treat?

Aileen McCrillis, MS, MPH


Top 10 Primary Care Apps

Drugs, diseases, guidelines, databases-all at the touch of an app. Here: a selection of smartphone/tablet applications that may make your clinical practice a little easier this coming year.

Aina Adekunle, MD


Recurrent Fever of Unknown Origin Responsive to Prednisone

There are no guidelines for the workup for classic FUO. Diagnostic modalities are guided by the spectrum of differentials as well as local prevalence of disease.

Akhil Bidani, MD, PhD


Case In Point: A man with renal failure, dyspnea, and an apparent lung mass

A 54-year-old man with chronic renal insufficiency presented with shortness of breath, nonproductive cough, and chest pain. The patient had hypertension, type 2 diabetes mellitus, and a 30-pack-year history of cigarette smoking. He denied alcohol or illicit drug use and prolonged exposure to asbestos, chemicals, or fumes.

© 2023 MJH Life Sciences

All rights reserved.