Obesity Medicine

A 62-year-old man who was receiving long-term corticosteroid therapy for Wegener granulomatosis presented with progressive leg weakness over 1 week. He had the stigmata of Cushing syndrome: moon facies, truncal obesity, and a dorsocervical fat pad.

A 78-year-old woman with carcinoma of the right colon underwent CT of the abdomen and pelvis to rule out metastasis. The scan showed a musculoaponeurotic defect above the left iliac wing, with a herniated loop of colon. A soft, reducible 4 × 6-cm mass that increased with coughing was found in her left flank. The patient had not had any surgery in this area.

A 42-year-old woman came to the emergency department because of hematuria for 1 day, a low-grade fever, and weight loss over the past 2 months. She denied having any abdominal pain or urinary problems. Pallor was the only noteworthy physical finding.

An obese 17-year-old boy sought treatment of an apparent abscess of the umbilicus. Hot soaks, black salve, and oral cephalexin were prescribed. Although there was some drainage, the lesion persisted and the patient returned for further evaluation.

For 2 years, a 60-year-old woman with long-standing hypertension had experienced worsening dizzy spells, fatigue, and chest discomfort. She also had cold extremities, significant dyspnea on exertion, and orthopnea. The patient was taking amlodipine and furosemide.

An obese 52-year-old woman with a 5-year history of type II diabetes mellitus had odynophagia and dysphagia for several days. She described the sensation as food “sticking” in her chest. She also complained of vaginal itching, polyuria, and polydipsia. The only remarkable finding on physical examination was candidal vaginitis. The patient did not smoke cigarettes or drink alcoholic beverages, and there was no history of recent weight loss.

Hyperpigmentation involving the neck developed in this 8-year-old obese girl. The affected area resembled unwashed skin. The patient had worn a uniform to school-a jumper and blouse with a collar-for 6 months.

Dyspnea, orthopnea, and weight loss sent a 40-year-old woman for medical consultation. Fifteen years earlier, the patient had been nephrectomized because of left kidney lithiasis. There was no history of other symptoms or diseases.

A previously healthy 51-year-old man presented with weight loss and poor appetite of 2 months' duration. He was heterosexual and had many sexual partners. Except for a temperature of 38.3°C (100.9°F) and left basal rhonchi, results of physical examination were normal. A chest radiograph and CT scan, as seen here, showed large cavitary lesions in the lower left lobe.

For 2 months, a 31-year-old woman had had dyspnea and dull, continuous retrosternal pain. She was admitted to the hospital, and a helical CT scan of the thorax identified a saddle pulmonary embolism. An ultrasonogram revealed deep venous thrombosis (DVT) in the left leg. Intravenous heparin was given; the patient was discharged, and warfarin was prescribed.

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.

A mass in the neck of a 65-year-old woman had grown slowly and progressively during the last 5 years. The patient was otherwise asymptomatic; in particular, there was no heat or cold intolerance, irritability, weight loss, increased appetite, palpitations, lethargy, constipation, dysphagia, or dyspnea.

During a routine preschool examination, it was noted that this 4-year-old boy, who weighed 30.8 kg (68 lb), did not seem to rotate his arms. The child's mother stated that she first noticed this 2 or 3 years earlier but thought it was related to her son's obesity. The youngster appears to function normally; he is able to write and play football and basketball. No other family members are known to be similarly affected.

A 6-year-old boy presented with bloody diarrhea; fatigue; decreased appetite; weight loss; and occasional, mild abdominal pain for the past 2 months. The child had 6 to 8 bowel movements daily, 1 or 2 of which occurred at night.

A 13-year-old girl who had leukemia presented to the emergency department with fever; chills; weight loss; fatigue; and a painful, erythematous rash with a central black lesion on the upper thigh. The patient was neutropenic and had been undergoing chemotherapy for 1 week.

A 6-year-old boy is brought for evaluation of bloody diarrhea, fatigue, decreased appetite, weight loss, and occasional, mild abdominal pain of 2 months' duration. The child had 6 to 8 bowel movements daily, 1 or 2 of which occurred at night.

The dark red plaques seen here developed rapidly under both arms of this markedly obese 43-year-old woman. The lesions spread concentrically, forming necrotic ulcerations with overhanging borders, and there was surrounding violaceous discoloration. No other areas of the patient's body were involved, and she was otherwise in good health.

Severe shortness of breath, a dry cough, and a 10-day history of fever sent a 37-year-old man with HIV disease to the emergency department. He complained of a poor appetite and had lost 10 lb over the last 10 days.

A 35-year-old Nigerian man presented to the emergency department with a distended, tender abdomen; fever; and weight loss. His abdomen had grown increasingly large during the past several months as his appetite diminished. The patient reported no allergies, took no medication, and denied tobacco, alcohol, and illicit drug use. His only significant medical history was jaundice during adolescence.

A 53-year-old woman had complained of pain in the lower right quadrant of her abdomen for 1 year. She claimed that the pain intensified when she bent forward in a particular position but believed it was unrelated to food, bowel movements, or urination. There was no weight loss, vomiting, or melena. There was no family history of colon cancer or inflammatory bowel disease.

A 30-year-old woman was brought to the hospital with syncope, bradycardia, and hypotension. For the past 6 years, she had vomited after eating meals and after occasional episodes of binge eating.

A 65-year-old man was hospitalized with dyspnea and fever of a few days' duration. He complained of excessive malaise, fatigue, and weight loss but denied any hemoptysis. The patient had a history of alcohol abuse.

A 41-year-old man with a past history of tuberculosis presented to the emergency department with massive hemoptysis. The patient denied fever or chills but reported a 20-lb weight loss and intermittent hemoptysis during the last 6 months. Six years ago, he had been treated for tuberculosis.

During the past few months, a 50-year-old woman had experienced cough, dyspnea, mild hemoptysis, and a 30-lb weight loss. She had no fever, chills, or rigors. The patient had smoked cigarettes for 30 years.

An obese 61-year-old man who had chronic obstructive pulmonary disease and sleep apnea heard a “pop” in his stomach while lifting a heavy weight; severe abdominal pain followed. He was short of breath the next morning, and his physician empirically prescribed cephalexin.