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Severe Pulmonary Alveolar Proteinosis in a Young Adult

  Pulmonary alveolar proteinosis is a rare lung disorder characterized by abnormal accumulation of surfactant within alveoli. Clinical presentation is nonspecific, but associated with characteristic radiologic findings and unique management options. We highlight a case of severe pulmonary alveolar proteinosis requiring total lung lavage in a young healthy man. Case Report A 37-year-old man with […]

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Hidden Giant: Medium Vessel Vasculitis as a Cause for Unresolving Fever

The purpose of this article is to determine if conversion from eating wild game harvested with lead-based ammunition to nonlead-based ammunition results in lower blood lead levels. Supersonic injection of toxin-leeching frangible projectiles into food is intuitively bad. As much as 95% of the ~13.7 million hunters in the United States choose shrapnel-inducing lead bullets […]

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Cardiac Tamponade: An Unusual Presentation of Systemic Lupus Erythematosus

A 55-year-old Ghanaian man was admitted to our service with 4 days of acute, progressive dyspnea. He developed orthopnea the night prior to his admission. Review of systems revealed progressive asthenia, anorexia, and low-grade fever for the past few months, with an unintentional weight loss of approximately 40 lbs. No other symptoms were elicited. The […]

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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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