A 66-year-old man presented with weight loss for 2 months, loss of appetite for several weeks, and abnormal chest radiographic findings. He denied chest pain, cough, fever, chills, shortness of breath, and chest trauma. He was an active smoker, with a 50-pack-year history of smok- ing, and a cocaine and alcohol abuser. His history included treatment of hypertension for 10 years and treatment of pulmonary tuberculosis 14 years previously.
High-resolution CT (HRCT) and galactomannan enzyme-linked immunosorbent assay (ELISA) are valuable in the diagnosis of invasive aspergillosis; however, both of these methods have limitations. Although the role of polymerase chain reaction (PCR) testing has not been established yet, the results of a study in the Netherlands are encouraging.
Abstract: Multidrug-resistant tuberculosis is defined as tuberculosis caused by strains that have documented in vitro resistance to isoniazid and rifampin. Treatment involves a regimen consisting of at least 4 or 5 drugs to which the infecting strain has documented susceptibility. These agents may include ethambutol, pyrazinamide, streptomycin, a fluoroquinolone, ethionamide, prothionamide, cycloserine, and para-aminosalicylic acid. In addition, an injectable agent, such as kanamycin, amikacin, or capreomycin, should be used until negative sputum cultures have been documented for at least 6 months. If the patient has severe parenchymal damage, high-grade resistance, or clinically advanced disease, also consider clofazimine, amoxicillin/clavulanate, or clarithromycin, although there is little evidence supporting their efficacy in this setting. Routine monitoring includes monthly sputum smear and culture testing, monthly assessment of renal function and electrolyte levels, and liver function tests every 3 to 6 months. (J Respir Dis. 2006;27(4):172-182)
A disorder similar to scleromyxedema, nephrogenic fibrosing dermatopathy, has been reported in patients receiving renal dialysis. Lichen myxedematosus, an atypical form of papular mucinosis, is not associated with sclerosis and paraproteinemia; however, it may represent an early presentation of scleromyxedema.
The mother of this 3-year-old boy noticed that his smile was asymmetric when he awoke that morning. He had been seen 3 days previously for left ear discomfort, sore throat, and a low-grade fever. Otitis media was diagnosed, and amoxicillin was prescribed.
Which of the rashes pictured here is tinea corporis?
How can recurrent episodes of noninfectious pericarditis best be prevented?
How can patients alleviate the burning sensation caused by eyedrops?
A spreading pruritic rash, an eruption of vesicles, an intermittently pruritic lesion--can you identify the disorders pictured here?
These patients have chronic paronychia. This inflammatory nail bed disorder is usually caused by prolonged exposure to wet environments and repeated minor cuticle trauma. Christopher Montoya, PA-C, of Beaverton, Ore, and Timothy R. Hurtado, DO, of Yongson, Korea, report that the nails of a 33-year-old man's right index finger and ring finger displayed multiple lateral grooves and edema near the eponychium.
A 63-year-old woman sought evaluation of asymptomatic, nontender, gradually progressing bilateral plaques on her shins. The lesions had arisen 8 months earlier as small, firm, red papules that spread peripherally. The papules had enlarged and developed atrophic centers. The patient had no history of glucose intolerance or diabetes.
A 50-year-old woman with breast cancer presented for follow-up 2 months after undergoing a left mastectomy and chemotherapy through a port catheter implanted in the right subclavian vein. Because venous access had been difficult to achieve, the catheter was left in situ after treatment.
The most common chronic blood-borne infection in the United States is caused by hepatitis C virus (HCV), an RNA virus transmitted through blood-to-blood contact. In this article, we identify risk factors for HCV infection and discuss which patients should be tested and treated.
Rheumatoid arthritis (RA) affects 1% ofadults during their most productiveyears and can result in significant disability.The goals of therapy are to reducepain, limit joint destruction, andpreserve function.
A 44-year-old homeless man complains of a “sore” onhis penis. The ulcer developed from a macular lesionon the glans penis about 5 days earlier. The painless ulcerhas not responded to a topical antibiotic ointment he receivedat another clinic.
A34-year-old woman presents to the emergency department(ED) with rapidly progressive dyspnea.The patient has a history of metastatic vaginal clearcell adenocarcinoma secondary to diethylstilbestrol exposurein utero. Following her diagnosis in 1990, she wastreated with surgery, chemotherapy, and radiation. Shehad done well for years until a recurrence of the cancer tothe left lung was found last year. She completed a courseof chemotherapy with doxorubicin hydrochloride andcisplatin 1 month ago.
A 54-year-old woman presents with severe, throbbingpain in her right shoulder that began 3 daysearlier. She has no history of trauma or of problems withthis shoulder. She denies shortness of breath, fever,chills, and rash.
A 36-year-old man with a 15-year history of episodic migraine presents to the emergency department (ED) at 5 AM witha right-sided throbbing headache of 4 hours' duration. The headache awakened him, which is typical of his more severemigraine attacks. Unfortunately, the patient forgot to refill his prescription for pain medication and did not "catch" thisheadache in time. He took an over-the-counter combination of aspirin and caffeine, which seemed to help for about 60minutes, but the headache has returned full force. He has vomited twice-another characteristic typical of his migraineattacks
A 47-year-old woman who wasseropositive for HIV-1 presented tothe emergency department with severemaculopapular, erythematouseruptions. Her antiviral regimen hadrecently been changed from zidovudine,300 mg bid; lamivudine, 150 mgbid; and saquinavir, 600 mg tid, tolamivudine, 150 mg bid; stavudine, 40mg bid; and nevirapine, 200 mg/d.
I enjoyed the Photo Essay by Drs Alexander K. C. Leung and C. Pion Kao on infectiousdiseases in children (CONSULTANT, March 2001, page 459).
The patient might havebeen exhibiting a phenomenon sometimes seen in methamphetamine users that isreferred to as "crank bug bites." Patients claim to see and/or feel bugs on theirbody and attempt to remove them or pick at them until they create open woundsand scabs.
A 34-year-old woman awoke with apainful, crusted ulcer on her upperarm. She has been repairing dry wallin her home but recalls no trauma.The necrotic ulcer features an erythematousborder.
In 1978, a ricin-filled pellet-which was injected with aspring-loaded device disguised in an umbrella-wasused to assassinate Bulgarian defector Georgi Markov.A similar device was employed unsuccessfully against asecond defector in the same year.1
Seizures are among the most common neurologic conditionsencountered in the primary care setting. However, they havereceived scant attention in standard textbooks and in themedical literature generally-perhaps because the topic cutsacross so many specialties. Here, an international team ofexperts fills this void with a comprehensive discussion of thecauses and management of seizures associated with a widevariety of medical problems-including organ failure,organ transplantation, electrolyte imbalance, endocrine disorders,cardiorespiratory disorders, cancer, fever and systemicinfection, medication, alcohol, illicit drug use, andenvironmental toxins. Chapters cover the various types ofseizures and their pathophysiology, how to distinguishseizure from syncope, seizures in the ICU, and the use ofanticonvulsants.
You routinely order laboratory screeningpanels, including serum liver enzymemeasurements, for nearly everypatient who has a complete physicalexamination or who is seen for any ofa host of other complaints. If you findabnormal liver enzyme levels, your familiaritywith the common causes andthe settings in which they occur mayenable you to avoid costly diagnosticstudies or biopsy.
