Substance-related Disorders

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A 71-year-old woman presents to the emergency department for evaluation of a blistering, intensely pruritic generalized rash that started 5 days earlier. Multiple ruptured and intact hemorrhagic bullae are obvious on the hands, arm, neck, chest, back, and abdomen and to a lesser extent on the lower extremities. The mucous membranes are spared. The Nikolsky sign is absent. The patient reports recent use of furosemide for periodic leg swelling.

A 38-year-old man found lying on the floor in his home was hospitalized because of alcohol intoxication. A chest radiograph showed a large calcified lesion in the left upper abdomen. A CT scan with intravenous contrast revealed a large, well-defined, cystic mass with mural calcification in the spleen. The CT findings were not consistent with a vascular malformation or echinococcal cyst-specifically, the mass was sharply demarcated, unilocular without septations, and round with a thin wall and attenuation similar to water. Urine Histoplasma antigen test results were negative.

Wernicke Encephalopathy

A 51-year-old man was hospitalized for subacute alteration of mental status. The patient had a history of alcohol abuse. He had no other medical disorders. Vital signs were normal. The patient scored 15 out of 30 on the Mini-Mental State Examination. He had an ataxic gait; all other physical findings were normal. The family reported that he had been treated in the emergency department 3 days earlier for hypoglycemia. Results of a complete metabolic profile and complete blood cell count were normal.

For 3 days, a 45-year-old woman with HIV infection who was noncompliant with her antiretroviral medications had cough, yellowish sputum, fever, and dyspnea. She denied hemoptysis, weight loss, or recent hospitalization. She had a long history of heavy smoking and alcohol and intravenous drug abuse.