Tag Archives: diagnostic dilemma

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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Renal Thrombotic Microangiopathy, Podocytopathy, and Chylous Ascites: A Hard-Nosed Diagnosis

Presentation A 67-year-old Sub-Saharan African man presented to an outside institution with progressive, painless abdominal distention, anorexia, leg swelling, and dyspnea on exertion. He had not seen a physician in many years. He denied alcohol use, intravenous drug use, or any recent surgery. He was referred to our institution for a second opinion. On physical […]

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Eyelid Metastasis in Non-Small Cell Lung Cancer: Diagnosis and Management

A 75-year-old man presented with a left lower eyelid lesion that had progressively enlarged over 2 months without bleeding, irritation, or change in vision. Shortly after noticing the eyelid lesion, he also noted hoarseness of his voice and enlarged lymph nodes in the left side of his neck. His review of systems was otherwise negative […]

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A Picture’s Worth: Giant Cell Arteritis

The ubiquitous smartphone became a helpful diagnostic tool when a patient used one to snap a photograph of her tongue. Although her symptoms were vague and nonspecific, her photograph facilitated the diagnosis of a serious, potentially debilitating illness. A generally healthy 63-year-old woman presented with a 1-week history of sore throat and periodic burning tongue […]

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