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Double Jeopardy: Autoimmune Myelofibrosis with Pyoderma Gangrenosum

A 33-year-old African American woman with no significant past medical history presented to an outside hospital with 3 months of oropharyngeal ulcers and odynophagia. She was also noted to be pancytopenic (hemoglobin 7.4 g/dL, mean corpuscular volume 81 fL, platelets 100,000/mm3, white blood cells 3000/mm3, absolute neutrophil count 600/mm3) with blood smear findings of teardrop […]

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Inside Out: Bone Marrow Necrosis and Fat Embolism

  Neurologic symptoms initially attributed to infection were ultimately the result of a devastating hematologic condition. The patient, a 57-year-old woman, was rushed to the emergency department for somnolence and slurred speech. She had experienced low back pain during the preceding week. Her medical history was notable for a ventriculoperitoneal shunt placed several years ago […]

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An Unusually Long Process: Eagle Syndrome

For a tiny subset of patients, an anomaly in the skull’s architecture can precipitate significant symptoms. That was true for a 34-year-old woman who presented with a 5-month history of diffuse neck pain that increased with movement. For the previous 3 months, discomfort was associated with the feeling that she had a lump in the […]

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Abdominal Tuberculosis Presenting as a Malignant Masquerader

  A previously healthy, immunocompetent, US-born, 48-year-old black woman presented with 6 months of subjective fevers, night sweats, and intermittent abdominal pain. Initial computed tomography scan (Figure 1) revealed a pancreatic versus peripancreatic mass and multiple liver lesions concerning for metastatic pancreatic cancer; percutaneous fine-needle aspiration (FNA) of the liver lesions revealed inflammatory changes and no […]

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The Enemy Within: Anti-N-Methyl D-Aspartate Receptor Encephalitis

Presentation A 31-year-old woman presented as a transfer from an outside hospital for the evaluation of progressive altered mental status. She had been in good health until 1 month previously when she began to experience intermittent dizziness and headaches. This was followed by behavioral changes (erratic crying and laughing) and new seizure-like activity, which included […]

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