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Myocardial rupture is the most feared and often lethal complication of acute MI. It was a potential diagnosis for this patient who presented with sinus tachycardia, ST-segment elevation from V1 to V4, II, III, and aVF with associated Q waves. Follow the workup and outcome here.  

Incomplete LV Rupture Secondary to MI: A Case of Intramyocardial Dissection

This 15-year-old has a pruritic, flat-topped, monomorphic papular rash on his face and arms for the past 6 days. He takes no medications, has not been sick recently, and has not been exposed to poison oak.

A.  Papular acrodermatitis of childhood (Gianotti-Crosti)

This monomorphic papular rash is unrelated to medications, recent sickness, or exposure to poison oak. It developed about 6 days earlier. 

Clinical Topics

Teen With Itchy Papular Rash on Face and Arms

This relatively small (1 cm), pigmented nodule of uncertain duration was noticed on the left arm of a 57-year-old man with a history of skin cancer.

This relatively small (1 cm), pigmented nodule of uncertain duration was noticed on the left arm of a 57-year-old man with a history of skin cancer. What do you suspect here?

Nodule With Dark Black Pigmentation: Your Dx?


An 11-year-old boy presents with a rash of tear-drop shaped scales spread symmetrically on his trunk and proximal extremities. The scale is adherent and attempts to scrape the lesions result in punctate bleeding. Other than a case of strep throat last week for which he was treated with antibiotics, he is otherwise in good health.

An 11-year-old boy breaks out quite suddenly with a rash of papulosquamous lesions with a silvery scale. Can you Dx? 

A Scaly Rash 

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Hard Purple Nodules: Your Dx?

A 5-year-old boy with a history of atopic dermatitis since 6 weeks of age, presents with a rash around his mouth that has been present for approximately 1 year. The patient’s mother reports that desonide topical cream was applied to the affected area for about 5 days, which initially resulted in improvement, however the rash returned after this medication was discontinued. The rash also recently improved after the patient took amoxicillin for an infection. She also notes that the patient has been licking his lips more frequently.

On examination there is an erythematous papulopustular eruption restricted to the perioral region, with sparing of the vermillion border. Mild hyperpigmentation is noted on the patient’s neck. There is no active involvement of other areas of the body.

The eruption has been present for 1 year and is restricted to the perioral region. What is included in your differential? 

Rash Around the Mouth of a 5-year-old Child

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

What's This "Red Spot"?

Mario Gonzalez, MD

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