Obesity

A verrucous birthmark, a rash at the commissure of the lips, proximalnail changes--can you identify the disorders pictured here?

A 72-year-old man presented after several months of dyspepsia and 1 day of hematemesis. He was not taking NSAIDs.

A 72-year-old morbidly obese man who had diabetes mellitus was admitted to the hospital from a nursing home with a fever of 4 days' duration. A tracheostomy had been performed 3 months earlier for respiratory failure. The patient was being treated with corticosteroids for chronic obstructive pulmonary disease.

A 45-year-old man presented with a 2-month history of progressive fatigue, weight loss of 10 lb, abdominal pain, and pruritus. The patient had been taking a maintenance dose of oral mesalamine since he received a diagnosis of ulcerative colitis 14 years before.

A 71-year-old man, who had recently returned from a month in Europe, complained of left lower leg swelling and pain of 1-week's duration. For many years, this obese patient had chronic venous insufficiency of both legs and chronic osteoarthritis of the knees that severely limited his ability to walk. The patient was admitted to the hospital with extensive cellulitis of the left lower leg.

After 6 weeks of persistent low back pain, an overweight 72-year-old woman sought medical evaluation. There was no history of trauma.

A 49-year-old woman, severely obese but otherwise healthy, appeared for a preemployment medical examination. She neither smoked cigarettes nor drank alcohol. She had no respiratory problems and recalled no family history of such. A baseline mammogram taken 4 years earlier showed no abnormalities, and the patient was not under care for any medical condition. Results of physical examination were normal, except for the obesity-which made it difficult to determine breast masses with confidence.

An 80-year-old woman presented with recurrent abdominal pain for 1 month, constipation, and vomiting. She had no diarrhea, rectal bleeding, or weight loss.

A 44-year-old woman had a painful, burning rash for 4 months. The erythematous eruption was evident on the thighs, fingers, buttocks, abdomen, and perineal and intergluteal areas. Application of triamcinolone cream and emollients offered no relief.

A 37-year-old woman presented with progressive dyspnea of 2 weeks' duration, a low-grade fever, and night sweats. She had been a healthy marathon runner until her exercise tolerance recently declined.

Over the past 6 months, a 72-year-old man was troubled by a persistent cough; he also had lost 9 kg (20 lb). He had no fever or chills, but he noticed mild streaking of blood in his sputum during the past month. He had been a cigarette smoker for 50 years.

Three weeks after undergoing gastric bypass surgery for obesity, a 64-year-old woman presented with fatigue, chills, and abdominal pain of 2 days' duration. She denied shortness of breath, nausea, vomiting, changes in bowel habits, melena, and hematochezia. The patient had no significant past medical history.

A 32-year-old man presented with a yellow, papular rash on the buttocks and extensor surfaces. His medical history included diabetes mellitus, alcoholism, obesity, and polysubstance abuse. Laboratory results disclosed a serum triglyceride level of 5,793 mg/dL.

For 2 months, an asymptomatic rash had been present on the upper arms of a 16-year-old boy of normal weight. The rash, as seen on the patient's right arm, consisted of abundant fine papules. He had no other lesions.

A 16-year-old African American boy complained of exertional pain below his left knee that severely limited his ability to participate in sports. The patient had had bilateral bowed legs until his early school years, when the right knee straightened. For the past year, exertional pain had been present below the left knee in the epiphyseal area.

HIV infection was diagnosed in a 34-year-old man 3 years before he was hospitalized. The patient had a 2-week history of nausea; vomiting; and diffuse, intermittent, poorly localized abdominal pain. He had received radiotherapy and chemotherapy for Kaposi's sarcoma (KS) of the upper and lower extremities, which had been diagnosed 8 months earlier.

A 73-year-old man was admitted to the hospital with pain in his hands, feet, and elbows. The patient, an alcoholic, had a 20-year history of hypertension and diabetes. Deformities of the hands and feet had developed during the past 5 years. Tophi were present over both ear lobes. The serum uric acid level was 15 mg/dL.

A 27-year-old man from Iraq presented with a painful lesion on the left lateral aspect of his tongue of 2 weeks' duration. Genital ulcers or skin lesions were not present. The patient also complained of a low-grade fever, weight loss, and occasional episodes of left eye pain during the past several months. He denied any significant past medical history, allergies, and the use of medications or illicit drugs.

For 1 month, a 25-year-old woman had experienced discomfort in and around the left eye and diplopia. She was in good health; she reported no weight loss, excessive nervousness, heat intolerance, decreased strength, changes in the texture of hair or skin, or altered bowel habits. There was no personal or family history of goiter or other thyroid disease.

After 5 weeks of undulating fever, weight loss, and night sweats, a 22-year-old man presented to the emergency department. He reported no significant medical history. The patient had recently completed a course of tetracycline followed by another of azithromycin for a presumed upper respiratory tract infection.

A 45-year-old man sought medical advice after suffering for 6 months with recurrent pain and a purulent discharge at the sacrococcygeal region. Two weeks before this consultation, an abscess on the patient's right buttock had been drained by another physician. The patient had insulin-dependent diabetes mellitus for 5 years; his medical history was otherwise unremarkable.

An obese 56-year-old woman was hospitalized after 2 days of chest pain, shortness of breath, and palpitations. Physical examination revealed no abnormalities, and serial cardiac enzyme studies and an ECG ruled out myocardial infarction. However, transesophageal echocardiography showed a lesion in the mediastinum.

With a 1-year history of episodic wheezing, a 62-year-old woman (a smoker for the past 30 years) was being treated for bronchial asthma, but bronchodilator therapy did not control her symptoms. She was hospitalized with worsening dyspnea and a 4.5-kg (10-lb) weight loss over the past 3 months. There was no hemoptysis.

A 52-year-old woman (a nonsmoker) was hospitalized after experiencing a low-grade fever and dyspnea for a month. No abnormalities were noted on physical examination, but the chest film showed multiple nodules, both well- and ill-defined. Lung biopsy confirmed the diagnosis of bronchoalveolar carcinoma.

A 2-year-old girl presents to the pediatric emergency department (ED) for evaluation of a fleshy mass protruding from her rectum. The mass, which had been present for 1 day, protruded spontaneously and not during defecation. There is no history of cough, constipation, diarrhea, vomiting, weight loss, or parasitic or chronic disease. However, the child has been having episodic, painless bleeding during the past month. There is no family history of GI disease.

A 40-year-old man was being treated as an outpatient with inhaled corticosteroids and bronchodilators for a presumed diagnosis of bronchial asthma. Worsening episodes of shortness of breath during the past few months sent him to the emergency department for a second opinion.

For 1 month, an 82-year-old woman had had episodes of coughing. Chronic bronchitis had been diagnosed; however, antibiotics and bronchodilators failed to control symptoms.

A 60-year-old woman with a 3-month history of cough, chest pain, and shortness of breath was brought to the emergency department. The patient denied any history of fever, chills, or rigors; she complained of mild hemoptysis for 1 week and a 9-kg (20-lb) weight loss during the last few months. The patient had smoked cigarettes for 40 years.

Intermittent dysphagia had bothered a 75-year-old woman for 6 months. She said that she felt an obstruction in her lower chest. Recent weight loss was attributed to the inability to swallow.

A 25-year-old man, who was an injection drug user, presented with a several-day history of dyspnea and fever. He complained of excessive malaise, fatigue, and weight loss but denied any hemoptysis. The examination of the lung revealed bilateral crackles in both lower zones.