A 3-mm long, double-tipped, polypoid lesion appeared just anterior to the anus on an 8-month-old girl 2 days earlier. The lesion was excised in the office: a local anesthetic was administered, and the base was lightly electrodesiccated. Antibiotic ointment was applied until the area healed. Pathologic findings identified an infantile perianal pyramidal protrusion.
Two years ago, Dr Alexander K. C. Leung reported on a case of pseudopseudohypoparathyroidism. The patient was a 13-year-old girl with short stature, short fourth metacarpals and metatarsals, mild mental retardation, and no identifiable biochemical abnormalities.
Significant burning and tearing of her eyes and eyelid swelling occurred soon after a 49-year-old woman had a permanent at a hair salon. Her ears also showed signs of a toxic burn. She had never before experienced such a reaction.
Presenting symptoms of this 42-year-old man were left pleuritic pain and severe dyspnea while climbing stairs. He had a 2-year history of exertional dyspnea but had not sought medical advice. The patient's pulse was 123 beats per minute; respiratory rate, 45 breaths per minute; blood pressure, 80/45 mm Hg; and temperature, 37.3°C (99.1°F). Chest examination revealed hyperresonance with absence of breath sounds over the left hemithorax and wheezing over the right lung.
A 79-year-old male nursing home resident with Parkinson's disease was brought to the emergency department after 3 days of severe constipation and inability to pass flatus. Examination showed generalized abdominal distention with tympany. Results of rectal examination were normal.
A 19-year-old man was admitted to the hospital with malaise, fatigue, and intermittent fever (temperature of 38°C [100.4°F]) for the last 2 weeks. Physical examination revealed scarce purpuric lesions over the lower extremities; a pericardial friction rub was audible over the precordium when the patient was supine and seated, and the spleen was remarkably enlarged.
A 60-year-old white man was evaluated for dyspnea on exertion. Hepatomegaly and abnormal skin pigmentation were noted, particularly in the upper extremities.
The unusual muscle definition in this 57-year-old man was noted during a routine physical examination. The patient had myasthenia gravis, for which he previously had been treated with prednisone.
A 44-year-old black man presented to our office with insidious onset of blurred vision. He had no significant past medical history but complained of dyspnea on exertion. On examination, the left pupil was irregular and fixed. A chest film demonstrated bilateral hilar adenopathy. Laboratory findings included normal purified protein derivative test results and elevated angiotensin-converting enzyme levels; pulmonary function studies appeared normal.
An excrescence at the 6 o'clock position at the anal verge is evident on this 8-day-old girl's anus. A hemorrhoid needs to be considered in the differential diagnosis of rectal bleeding in all age groups, since the condition can be present in neonates as well as adults.
For 2 months, a 73-year-old man had experienced dysuria, pneumaturia, and foul-smelling urine. He had an attack of diverticulitis a year earlier. At that time, he underwent a barium enema study, which showed multiple sigmoid colonic diverticula with spasm.
Levofloxacin, 500 mg/d, had been prescribed for a 74-year-old woman who had a urinary tract infection. The patient had type 2 diabetes and hypertension. She was allergic to sulfa drugs.
A 72-year-old woman was hospitalized after 8 years of pain and swelling of the right metatarsophalangeal joint. (In this film, the dark area over the distal joint of the large toe is an artifact.) Results of a purified protein derivative tuberculin test were positive, and a chest film revealed apical changes compatible with old tuberculosis (TB).
A 73-year-old man was admitted to the hospital with pain in his hands, feet, and elbows. The patient, an alcoholic, had a 20-year history of hypertension and diabetes. Deformities of the hands and feet had developed during the past 5 years. Tophi were present over both ear lobes. The serum uric acid level was 15 mg/dL.
A 15-year-old boy had been experiencing pain in his distal left leg for 7 months. There was mild swelling, and an x-ray film of the lower leg revealed a sharply marginated, vertically oriented, tubular lucency in the metaphysis of the tibia (A). There was no cortical destruction, periosteal reaction, or pathologic fracture. An MRI at high field strength was performed to narrow the differential diagnosis.
This 40-year-old man was punched in the left eye the night before his evaluation.
For many years, a 71-year-old multiparous woman had a painless swelling around her umbilicus that intermittently and spontaneously decreased in size.
Twelve years after having her ear pierced, a 58-year-old woman presented with a keloid on the right lobe's medial surface.
Eyelid spasms and uncontrolled blinking impaired a 75-year-old man's ability to ambulate and to drive. Bright light aggravated the spasms.
Two asymptomatic lesions that had been present for 1 year on the left upper chest of a 61-year-old man were excised. Pathologic examination revealed the raised, dark brown medial lesion to be an interdermal nevus; the lateral, light tan lesion with papules (arrow) was a papillomatous interdermal nevus with primary macular amyloidosis.
