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One Thing after Another: Ecthyma Gangrenosum

Chronic high-dosage steroid therapy can pose a significant risk factor for infection due to its immunosuppressive effect. A 70-year-old African American man presented with acute bilateral painless vision loss. An investigative work-up produced a positive antinuclear antibody titer of 1:1280 with a speckled pattern, a positive test for anti-Ro/anti-Sjögren’s-syndrome-related antigen A antibody, and an erythrocyte […]

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Site-Seeing: Hereditary Hemorrhagic Telangiectasia with Native-Valve Endocarditis

A 69-year-old Japanese man had 2 disparate illnesses with a comparable sign. The first, an undiagnosed genetic disease, made him more susceptible to the second. He was admitted to our hospital after reporting a 1-month history of chills, malaise, anorexia, pain in the left knee, and blurred vision in the right eye. He denied urinary […]

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On the Palms of His Hands: ACTH-Induced Hyperpigmentation

The prominent hyperpigmentation marking a patient’s skin was tied to his worsening diabetes mellitus type 2, though the connection was not immediately obvious. Five months prior to presenting to our institution, a 31-year-old man, whose diabetes type 2 had been well controlled for a long period of time, was evaluated in a private endocrinology practice […]

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Disseminated Zoster After Trauma in an Immunocompetent Patient

  An 88-year-old man presented to the emergency department with dizziness and vesicular lesions in various stages of healing on the right lateral face, right ear, arms, legs, and chest. Incidentally he reported a ground-level fall in which he struck his face 2 days prior. The facial lesions were thought to be cellulitis, and he […]

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Four Cancers and a Rash: Henoch–Schönlein Purpura

A patient who had a history of 4 primary malignancies developed a rash that is usually seen among children. The 65-year-old man presented with a 2-day history of anasarca, painless skin lesions, and new arthralgias in both hands. He had a previous diagnosis of amyotrophic dermatomyositis, and although he had none of the typical skin […]

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