A 43-year-old woman was hospitalized with a 3-day history of fever and back pain. She was malnourished and seropositive for HIV infection. Results of blood and sputum cultures were negative. A community-acquired pneumonia was diagnosed. Chest film findings and the clinical presentation were inconsistent with Pneumocystis carinii pneumonia.
A 1-cm, tan-brown lesion had developed years earlier at the posterior helix of a 61-year-old man's right ear. Central ulceration and crusting were noted on the papule. The patient sought medical evaluation when the lesion became nodular and began to flake.
A 10-year-old boy presented with right hip pain and a limp. The patient was taking no medications and had no personal or family history of disease. He denied a history of trauma.
A 65-year-old woman presents with a 1-cm raised, light brown, circular, nodular lesion on the top of her head, which has progressively enlarged during the last 6 months.
A firm mass projected from the deltoid muscle region of a 24-year-old man's right shoulder.
This newborn has trisomy 18, as manifested by intrauterine growth retardation (birth weight, 2350 g; length, 47.2 cm), microcephaly (head circumference, 31.5 cm), short neck, hypotonia, feeding difficulties, high-pitched cry, micrognathia, cleft palate, low-set ears, short sternum, widely spaced nipples, clenched hands with ulnar deviation and overlapping digits, micromelia, and a single umbilical artery.
Cleft lip and palate is a common congenital facial malformation that occurs once in about every 750 births among Caucasians.
In a 65-year-old man with a family history of colorectal carcinoma, an initial screening coloscopic examination revealed 2 arteriovenous malformations. These delicate red lesions with a vascular network and irregular edges were found in the cecum.
The parents of a 10-year-old boy of normal intelligence brought him for evaluation because of his tall stature. He was 154 cm tall (3 cm above 97th percentile) and weighed 34.3 kg (50th percentile). He exhibited significant arachnodactyly, with an upper to lower segment ratio of 0.8 and an arm span to height ratio of 1.1. He had a long, angular face with a high arched palate and crowded dentition, ptosis, myopia, superior lens subluxation, pectus excavatum, widely spaced and low-set nipples, grade 2/6 ejection systolic murmur at the left sternal border, midthoracic scoliosis, joint hypermobility, positive thumb sign and wrist sign, and pes planus.
A previously asymptomatic, large black plaque on a 65-year-old man's scalp recently began to bleed. The lesion had grown considerably since it first appeared as a small black macule 3 years earlier.
This 19-month-old child exhibits the characteristic features of hypomelanosis of Ito, a neurocutaneous disorder.
A 45-year-old woman presented with a slowly enlarging, mildly tender lesion on the left sole. The large indurated plaque was studded with multiple firm papules and nodules that involved the instep and extended onto the medial aspect of the foot. There was no regional adenopathy.
A 74-year-old man had vague abdominal pain, jaundice, pruritus, gray stools, and dark urine. A painless, palpable mass in his right upper quadrant was found at examination.
An 11-year-old boy presented to the hospital with a 3-day history of maculopapular rash over the face, trunk, and extremities. He had completed a 5-day course of trimethoprim-sulfamethoxazole for otitis media 1 week before presentation. His medical history was otherwise unremarkable. Over the past 3 days, the rash had become pruritic and the lesions progressively larger. Some lesions were vesicular and bullous. There was diffuse involvement of the oral mucosa, conjunctivae, and genitalia.
A 43-year-old woman was admitted to the hospital with left flank pain. The physical examination revealed a left abdominal mass. Laboratory test results identified normochromic-normocytic anemia (hematocrit, 33%; hemoglobin, 10.8 g/dL; and mean corpuscular volume, 88 fL) and microscopic hematuria (10 red blood cells per high-power field).
The left foot of this 4-month-old boy has a convex sole with a rocker-bottom appearance, hindfoot equinus, and midfoot and forefoot dorsiflexion.
A 55-year-old man claims that the clubbed appearance of his fingers had been present “as long as I can remember.” This patient has hereditary clubbing of the distal phalanges of all fingers; his toes are similarly affected.
A mass on the left side of the scrotum was the presenting complaint of a 7-year-old boy. The mass increased in size when the child cried, strained or coughed. Physical examination showed a left scrotal mass that was reducible with manipulation when the child was lying down. The left spermatic cord was found to be thickened-the "silk" sign.
A 50-year-old man with a history of diabetes, hypertension, seizure disorder, and alcohol abuse sought treatment for a rash and painful ulcerations of the hand, face, and scalp, which had bothered him for 1 month. The patient also complained of pruritus.
A 67-year-old man had been hoarse since undergoing a thyroidectomy for carcinoma nearly 3 months ago. Indirect laryngoscopy now confirmed paralysis of the right vocal cord, which was fixed in the paramedian position. The left vocal cord appeared normal.
