Tag Archives: diagnostic dilemma

A Red Herring in the Green Grass: Syphilitic Membranous Glomerulonephritis

Physical discomfort attributed to a routine chore was actually an unusual presentation of an insidious infection. A 51-year-old man presented to the emergency department and reported 1 week of persistent, localized lower back pain that began after he had spent the day mowing his lawn. He denied any trauma, rash, dysuria, discoloration of urine, or […]

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An Uncommon Cause of Obstructive Jaundice: An Infrequent Neoplasm

A 42-year-old man was admitted to the Johns Hopkins Hospital with right upper quadrant abdominal pain and scleral icterus of 3 weeks duration. The pain was described as aching and cramping in quality that typically occurred after meals. He had no vomiting or diarrhea but did note acholic stools and had more recently developed diffuse […]

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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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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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