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Polymyalgia Rheumatica with Normal Inflammatory Markers

A 70-year-old man presented with pain in his shoulders, low back, and thighs for 1 year. He had difficulties when changing clothes, taking a bath, and getting out of bed because all these body movements aggravated the pain. He also experienced morning stiffness for 1 hour. Although his weight decreased by 5 kg because of loss […]

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Diabetic Cystopathy with Bilateral Hydronephrosis

A 40-year-old man with poorly controlled diabetes mellitus (glycated hemoglobin 19%) with related peripheral neuropathy, nephropathy, and proliferative retinopathy presented with epigastric discomfort, anorexia, polyuria, polydipsia, nausea, and diminished urine output. His longstanding use of insulin was halted in the preceding month owing to termination of employment and loss of health insurance coverage. Examination revealed […]

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Atypical Cause of Functional Decline in Parkinson’s Disease

A 74-year-old Chinese man with past medical history of Parkinson’s disease presented with rapid functional decline over 2 months. From being able to ambulate independently, he had become bedridden and was dependent in activities of daily living. On admission, he was also noted to be coughing on eating and had visual hallucinations for 2 weeks […]

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young female doctor examines x-ray

A Depressing Diagnostic Error

To the Editor: A 52-year-old woman with diabetes presented to the hospital with acute onset of right flank pain, in the setting of profound lower extremity weakness and cachexia with a 30-lb unintentional weight loss over the past 6 months. She was diagnosed with ascending pyelonephritis and treated with empiric antibiotics. On hospital day 2, […]

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Elongated Mitral Valve Vegetation

To the Editor: A 41-year-old woman presented with a 2-week history of neck and back pain and suddenly developed pulseless electrical activity cardiac arrest while in the emergency department, with return of spontaneous circulation after 2 rounds of advanced cardiac life support. Physical examination and labs were notable for fever, sinus tachycardia, leukocytosis, and lactic […]

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