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Ocular fundus image of the left eye shows mild optic disc swelling, multifocal retinochoroidal exudates, retinal phlebitis, and mild vitreous opacity.

Sometimes the Eyes Say More Than the Mouth

A 48-year-old man with a history of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS)-associated cryptococcal meningitis was referred to our hospital with blurred vision in his left eye for several months. He was diagnosed with bilateral chronic posterior uveitis (Figure). After ruling out secondary uveitis, such as sarcoidosis, Behçet disease, Vogt-Koyanagi-Harada disease, […]

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Critical role of feedback in clinical reasoning. (A) Feedback reinforces decisions that lead to correct diagnoses and (B) allows for recalibration when necessary. (C) In the absence of feedback, clinicians may continue inappropriately on a default pathway.

Anchor’s Away: A Case of Apparent Sinusitis

Diagnostic errors, defined as failures to reach timely and accurate explanations for a patient’s presentation, affect the majority of our patients, because most will experience at least one diagnostic error in their lifetime.1 We report the case of a patient who was inappropriately diagnosed with acute bacterial rhinosinusitis and later found to have lymphoma. We use […]

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Bone marrow biopsy showing increased reticulin fibrosis: hematoxylin and eosin (H&E) ×100 (A), H&E ×200 (B), and reticulin ×200 (C). Peripheral blood smear showing anisopoikilocytosis and occasional teardrop cells (D).

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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Systemic Lupus Erythematosus in an Elderly Man

  We present the case of an 84-year-old white man with a remote history of an axillary liposarcoma and basal cell carcinoma who presented to the emergency department after 4 days of knee pain, extreme fatigue, weakness, and malaise. Although he was without chest pain, his electrocardiogram showed diffuse ST elevations. There was no troponin […]

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Tumor Melt

Tumor Melt: Primary Effusion Lymphoma of the Heart A 45-year-old African-American man with a history of acquired immunodeficiency syndrome presented with exertional syncope. Other pertinent symptoms included progressive dyspnea, lower-extremity edema, poor appetite, fevers, and 60-lb weight loss. The outpatient medication regimen included tenofovir/emtricitabine, ritonavir, and atazanavir with a CD4 count of 173 and a […]

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