A 42-year-old woman complained of facial puffiness, fullness, and redness for 2 weeks, which were gradually becoming more severe. She also noticed a sensation of “heaviness” in her head. The patient had no significant past medical history. She denied having a cough, shortness of breath, hoarseness, allergies of any kind, and neurologic deficits. Her weight and appetite were unchanged. She had smoked a pack of cigarettes every day for the past 20 years.
Cutaneous photosensitivity followed by acute, then chronic, skin lesions on sun-exposed areas characterizes this disorder.
Two 7-year-olds show the purpuric rash of the lower body and legs that is typical of Henoch-Schönlein purpura. This disease is a vasculitis that chiefly affects small vessels of the skin, joints, gastrointestinal tract, and kidney.
A 55-year-old woman, who had fairly well-controlled type 2 diabetes for 15 years, noticed a slow, progressive decrease in the visual acuity of her right eye during the past 6 to 8 weeks.
A 72-year-old woman who was being evaluated for medical clearance for an elective cholecystectomy was asymptomatic, except for biliary colic. She had had pulmonary tuberculosis (TB) 40 years earlier, for which she had undergone surgery on the right hemithorax-a fact borne out by a thoracotomy scar. An x-ray film of her chest, shown here, demonstrates numerous plastic balls in the right thoracic cavity. This is an example of collapse therapy for pulmonary TB, which was practiced years ago, before the availability of effective antituberculous medications.
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.
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.
For 1 week, a 22-month-old boy experienced gradually increasing facial swelling followed by swelling of the abdomen and legs. His mother reported that the child's urinary output had markedly decreased. During this period, the youngster gained 5 lb.
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.
Acute allergic reactions from the bites of the common dog tick, Dermacentor variabilis, resemble reactions from bites of mosquitoes and other insects. Following removal of the tick from the patient's back, this inflamed, pruritic plaque developed at the site. Once all parts of the tick are removed, these bites generally respond to topical corticosteroids.
Proximal bilateral upper extremity weakness had slowly progressed in a 34-year-old woman until she could no longer raise her arms above her shoulders. She first noticed the weakness at age 18; previously, she had been active in sports and her development had been normal.
This neonate was born with a high arched and cleft palate and a small jaw-the result of Pierre Robin syndrome, an autosomal recessive disorder also characterized by micrognathia and pseudomacroglossia.
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.
A 65-year-old woman had had diarrhea for 1 year. Stool studies were negative for occult blood, and flexible sigmoidoscopy revealed a cobblestone-patterned colonic mucosa. A detailed history revealed that for the past year, the patient had been taking a daily herbal multivitamin supplement, the ingredients of which included cascara. Her diarrhea resolved completely when she stopped taking the pills.
Alimentary tract duplications are uncommon. Gastric duplication accounts for only 3.8% of these duplications. The cause is not known, but faulty separation of the endoderm and notochord early in embryonal development is thought to be responsible. The anomaly occurs in twice as many female as male infants.
A 56-year-old woman was bothered by “something protruding” from her vagina. She had no pain, bleeding, or dyspareunia.
A 51-year-old man-a 6 ft, 240 lb bodybuilder-presented with long-standing, chronic rotational instability of the left knee as the result of a valgus blow to the joint during a football game 20 years earlier. The patient complained of extreme pain and reported that he felt the tibia sliding around under the left femur.
An 11-year-old girl presented with central clefting and syndactyly of the third and fourth digits of the right hand; sparse, fine blond scalp hair; sparse eyebrows; and numerous dental caries. Past health was unremarkable except that she had stenosis of the nasolacrimal ducts, which required probing when she was 1 year old. Her mother also had somewhat sparse and fine scalp hair and similar hand malformations with ridged and slow-growing nails, as well as mild conductive hearing loss.
A female infant was born vaginally to a gravida 4, para 1, 24-year-old woman at term. The child's birth weight was 2,800 g; her length was 51 cm. The mother had a history of three spontaneous abortions. The present pregnancy was complicated by threatened abortion at 15 weeks. The mother was given hydroxyprogesterone hexanoate, 500 mg IM weekly for 6 weeks.
A 34-year-old woman who has had constipation and episodes of obstipation for at least 5 years recently passed blood and mucus rectally and has a rectal prolapse. Colonoscopy revealed an ulcer on the anterior rectal wall, approximately 4 cm from the anus.
