Tag Archives: diagnostic dilemma

Four Cancers and a Rash: Henoch–Schönlein Purpura

A patient who had a history of 4 primary malignancies developed a rash that is usually seen among children. The 65-year-old man presented with a 2-day history of anasarca, painless skin lesions, and new arthralgias in both hands. He had a previous diagnosis of amyotrophic dermatomyositis, and although he had none of the typical skin […]

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Not so Obvious: Acute Herpes Esophagitis

  The gross examination immediately suggested infection with Candida species, but biopsy results pointed to a different culprit. A 29-year-old woman sought care in the emergency department after experiencing sharp epigastric pain over 2 days. She was initially seen at an urgent care center and empirically treated for gastritis with omeprazole. However, her pain progressively worsened and […]

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More than a Mite Contagious: Crusted Scabies

Although an extensive skin infestation might be expected to cause serious discomfort, this is not always the case. A holiday visit sparked concern among family members when they saw that their relative, a 53-year-old woman who lived alone, was unable to perform routine daily activities. They brought her to the hospital to be evaluated for […]

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Provoked Dizziness from Bow Hunter’s Syndrome

  A 62-year-old man was experiencing debilitating bouts of dizziness provoked by head rotation until ultimately finding relief with cervical spine fixation. He had a history of coronary artery disease, human immunodeficiency virus, tobacco use disorder, and generalized anxiety, and initially presented to a routine primary care visit with 3 weeks of episodic dizziness. During […]

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An Unusual Presentation of Thrombotic Thrombocytopenic Purpura

  We describe a patient with sudden and severe postoperative thrombocytopenia whose diagnosis was delayed. The patient was a 58-year-old black man with diabetes mellitus type 2, hypertension, and chronic kidney disease, who presented to our institution with 4 days of abdominal pain. He had a history of remote exploratory laparotomy for an abdominal gunshot […]

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