Infection

A 14-month-old infant was brought by his mother for evaluation of fever (temperature, 39.4ºC [103ºF]) and a tender, indurated, warm area with surrounding edema and a centrally located papule in the left groin.

Several readers wrote in response to Dr Andres Pinto’s “Consultations & Comments” answer to a question about treatment options for a patient with severe aphthous ulcers (CONSULTANT, May 2008, page 411). The additional treatments suggested by these readers appear below, along with Dr Pinto’s comments.

It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Patients with sudden flailing movements or unresponsive staring may, in fact, be experiencing psychogenic events. Other types of pathological spells, such as syncope and migraine, can also be mistaken for epileptic seizures.

An 84-year-old Ethiopian woman presented with tender, violaceous, nonblanching nodules that had coalesced into plaques on the soles of both of her feet over the past 3 months. Similar discrete nodules were found on the dorsal aspect of her right wrist.

A 59-year-old woman presents with right-sided, nonradiating, “aching” chest pain that has been continuous and increasing in severity for the past 3 days. It began as a tightness that gradually became more painful; it is aggravated by palpation and movement and has not been relieved by acetaminophen.

A 46-year-old man with AIDS (CD4+ cell count, 150/μL) presented with a painful nodular lesion on the plantar surface of his right foot. The lesion had appeared 1 month earlier as a painless, 1-cm, raised, reddish purple nodule and had progressively enlarged to 5 cm. Six months earlier, the patient had cryosurgery to remove a similar, larger lesion on the posterior aspect of his right midcalf.

For a week, a 36-year-old Marine had clusters of localized papular lesions on the right forearm; he had no systemic symptoms. The patient had been inoculated 20 days earlier in the United States with the vaccinia virus (smallpox vaccine) to the ipsilateral shoulder just before deployment. He had no history of eczema, psoriasis, or drug allergies.

For 10 years, a 32-year-old woman has had an asymptomatic rash on both sides of her neck. She is otherwise healthy.Do you recognize this rash?

The term “anaphylaxis” (without protection) was first coined by Richet and Portier in 1902 to describe a “supersensitivity” reaction they observed while attempting to produce tolerance to sea anemone venom in dogs. During their experiments, an unforeseen event occurred.

A 9-year-old asymptomatic boy was referred to our tertiary care facility with a blood lead level (BLL) of 59 μg/dL. A diagnosis of attention deficit hyperactivity disorder, which was managed with amphetamine/dextroamphetamine, had been made when the patient was 6 years old.

Together the spondyloarthropathies form a group of overlapping chronic inflammatory rheumatologic diseases that show a predilection for involvement of the axial skeleton, entheses (bony insertions of = ligaments and tendons), and peripheral joints. They also may involve extraskeletal structures, especially the eyes, lungs, skin, and GI tract.

For 3 days, a 45-year-old woman with HIV infection who was noncompliant with her antiretroviral medications had cough, yellowish sputum, fever, and dyspnea. She denied hemoptysis, weight loss, or recent hospitalization. She had a long history of heavy smoking and alcohol and intravenous drug abuse.

An 18-year-old woman with a history of allergic rhinitis and moderate persistent asthma presented with right-sided nasal congestion of 6 months’ duration. Her symptoms persisted despite her usual allergy medications, allergen immunotherapy, and 2 courses of antibiotics. A sinus CT scan showed complete opacification of the right maxillary sinus with increased attenuation of the mucin. Allergic fungal rhinosinusitis was suspected, and an otolaryngologist was contacted.

A healthy 22-year-old man presents with asymptomatic dark streaks on his abdomen that occurred 1 week earlier while he was on a cruise in the western Caribbean. He says that he shaves the hair on his abdomen.

Tell patients not to wash their hands after they apply medication to treat scabies or lice.

For 5 weeks, a 27-year-old man had a rash with painful fissures on his hands. For the past 2 weeks, he also had mildly pruritic red, scaly lesions on his trunk. He was otherwise healthy, had no allergies, and did not take any medications. The patient denied the use of tobacco, alcohol, and illicit drugs.

Should acute infection with hepatitis C virus (HCV) be treated? If yes, what is the recommended treatment?

The prevalence of anal human papillomavirus (HPV) infection was 24.8% among a study population of 222 heterosexual men who confirmed that they had never engaged in male-male sexual intercourse. 1

The CDC's Advisory Committee on Immunization Practices (ACIP) recommends that all persons older than 60 years be immunized against herpes zoster with a single dose of the live, attenuated virus vaccine. Furthermore, it urges clinicians to offer the vaccine at the first available clinical encounter.

An article in The New York Times succinctly summarized the World Health Organization's (WHO) recent report on the leading causes of death in the world: "As the world's population ages, gets richer, smokes more, eats more, and drives more, noncommunicable diseases will become bigger killers than infectious ones over the next 20 years."

A 55-year-old woman seen because of new lump under right side of her jaw; present for 24 hours. Associated neck discomfort causing dysphagia, and also a raspy turn to the voice; both much worse in last 12 hours. No dyspnea. No sore throat.

During the past few years, several vaccines have been added to the adult immunization schedule. The human papillomavirus (HPV) vaccine is recommended for girls and women aged 11 to 26 years (minimum age, 9 years) to prevent cervical cancer, precancerous or dysplastic lesions, and genital lesions caused by HPV types 6, 11, 16, and 18.

The family of a 49-year-old Chinese man brings him to the hospital after he becomes confused and disoriented. For about a week, the patient has had cough, cold symptoms, dizziness, and occasional vomiting.

High morbidity and mortality are associated with non-food-borne Vibrio infections, particularly those caused by Vibrio vulnificus (Figure), a species that is endemic to the Gulf Coast of the United States

The numerous symptom domains of fibromyalgia syndrome (FMS) include pain, fatigue, sleep disturbance, mood disturbance, function impairment, irritable bowel syndrome, tension and migraine headache, and cognitive dysfunction. Its pathophysiology is rooted in neural dysregulation in the spinal cord and brain.

A 27-year-old primigravida is seen 3 weeks before expected date of confinement, with a 1-week history of vulvovaginal pain and a yellowish white discharge.

A Photo Quiz to Hone Dermatologic Skills

Survivors of childhood cancer frequently present to primary care practitioners for a routine physical examination or for urgent care. Knowledge of the patient's cancer history and of the specifics of the treatment are essential to providing proper care and addressing his or her unique risks.

The emergence of antimicrobial resistance has increasingly impeded the management of a number of clinically important infections.

A 54-year-old woman presents with an asymptomatic rash of sudden onset on both malar cheeks that developed 1 day earlier. She denies any facial trauma.