Infection

A 38-year-old man presented with a 2-week history of mental status changes and impaired memory. He also had a rash on both hands and feet that had been getting worse for the past few months.

What's your diagnosis? For hints and clues, click here. Rash Decisions

A 66-year-old woman presented with a 2-day history of acute onset of redness, pain, and swelling of the right breast.

An 8-year-old child has intensely pruritic lesions on the thumbs, adjacent dorsum of the hand, soles of the feet, and navel. Vital signs are normal. The patient is otherwise healthy and has no recent history of exposure to poison ivy.

A 17-year-old sexually active young woman presented with sudden loss of vision in the left eye 2 weeks before presentation.

For the past 2 weeks, this 46-year-old woman had had malaise, myalgia, and hand and elbow arthralgia. Twelve hours before she was hospitalized, red spots started to appear on her shins and thighs. Soon afterward, her left ankle became increasingly painful, tender, and warm.

The first 5 months of 2011 have seen the highest number of measles cases in this country in almost a decade.

A 59-year-old woman with chronic hepatitis C presented with abdominal pain that had grown progressively worse during the past 3 months.

Match each picture with the phrase below that best describes it. The pathogenic organisms in these picturesmight be microscopic or macroscopic, and they can be recovered from skin lesions or clothing by the patientand/or clinician. Answers and discussion appear on the following page.

The nasal cellulitis that affects this 39-year-old woman began as right intranasal folliculitis.

A 43-year-old African American woman presented to the emergency department with severe dyspnea, wheeze, and cough productive of white sputum. Three years earlier, she had been given a diagnosis of asthma based on symptoms of wheeze and cough; her treatment regimen included intermittent use of albuterol.

During the past year, a 48-year-old man has had joint pain as well as this worsening rash on his hands. He is a construction worker, and he attributes the symptoms to his occupational exposure.

Here: a succinct review of the diagnosis and treatment of pemphigus vulgaris, dermatomyositis, cicatricial pemphigoid, linear IgA bullous disease, coma bullae, and stasis bullae.

For 4 weeks, a 49-year-old man has had progressively worsening pain between his scapulae and in the lower part of his neck. The pain is now severe, and he takes high doses of acetaminophen and NSAIDs for relief.

A variety of effective treatments are available for diabetic peripheral neuropathic pain (DPNP), including topical agents, oral medications, and nondrug approaches. The lidocaine patch 5% is recommended for relatively localized pain.

After 6 weeks of scratching a very itchy, worsening rash on his left leg, a 53-year-old man seeks medical evaluation. He has tried over-the-counter (OTC) topical remedies with no success.

This HIV-positive, 48-year-old man presented with new-onset acne-like, pruritic lesions on his face. These erythematous painful papules had developed 2 months before presentation. The patient was taking antiretrovirals and trimethoprim/sulfamethoxazole for the HIV infection.

A 50-year-old man was brought to the emergency department (ED) after a witnessed syncopal event. He was awake but confused and unable to provide a history.

The treatment of chronic fatigue syndrome (CFS) is mainly supportive. The key to effective management is to establish a therapeutic alliance with patients and to convey a consistent message that their complaints are taken seriously. Although spontaneous recovery is rare, it does occur in some patients with CFS.

For 20 years, a lesion has been slowly growing on the penis of a 51-year-old man. He has noted bleeding and a foul-smelling discharge from the mass. Recently, the patient experienced a 30-lb weight loss. He has had 5 sex partners in his lifetime but has been monogamous for the past year.

A 22-year-old woman presented to her primary care physician’s office with right lower quadrant and suprapubic abdominal pain. She stated that the pain had begun earlier that day; she had no symptoms on awakening that morning.

Bacterial meningitis and herpes simplex virus type 1 (HSV-1) encephalitis are both associated with significant morbidity and mortality. Thus, hospitalization and prompt initiation of therapy are essential.

For 3 weeks, a 28-year-old man has had a pruritic, bilateral axillary rash. He stopped using deodorant, but the condition has not improved.

After 6 weeks of coping with itchy lesions on her arms and legs, a 43-year-old woman seeks medical advice. The rash first erupted with the onset of cold weather.

Chronic fatigue syndrome (CFS) is a distinct disorder characterized by debilitating and often recurrent fatigue that lasts at least 6 months but more frequently lasts for longer periods. Patients with CFS experience overall physical, social, and mental impairments and may subsequently qualify for medical disability.

A 41-year-old woman presents to the emergency department with chest pain and dysphagia. Routine laboratory studies reveal profound neutropenia. She denies recent fever, chills, or weight loss.

The physical exam – looking into the eyes and throat, taking the blood pressure, sounding the chest – is part of the process of medical diagnosis. It's one way a physician attempts to determine the cause of a patient's complaint.

A 48-year-old man was admitted with a sore throat, subjective fever, and cough of 2 days’ duration. Two days before admission, he had dysphagia, began to drool, and felt like he was choking.

For 4 months, a 45-year-old man with a history of alcohol abuse had made multiple visits to the emergency department (ED) and a dermatology clinic for evaluation of a diffuse, scaly, and intensely pruritic rash. The rash, which was photosensitive, had started on his upper extremities and spread proximally to the trunk and lower extremities.