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Selected cuts from magnetic resonance imaging of the spine.

Atypical Cause of Functional Decline in Parkinson’s Disease

A 74-year-old Chinese man with past medical history of Parkinson’s disease presented with rapid functional decline over 2 months. From being able to ambulate independently, he had become bedridden and was dependent in activities of daily living. On admission, he was also noted to be coughing on eating and had visual hallucinations for 2 weeks […]

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Doubly Dangerous: Extranodal NK/T-Cell Lymphoma

The patient’s disease was already very advanced when the diagnosis was determined, and a hazardous complication was developing as well. A 63-year-old woman presented with a 2-month history of symmetrical violaceous swelling of the face (Figure 1A). Faint violaceous patches also marked her neck, upper chest, upper back, and both arms (Figure 1B). In addition, she had been […]

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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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(A) Computed tomography of the chest showed mediastinal lymphadenopathy. (B) Supraclavicular lymph node histopathology identified Hodgkin's lymphoma. The blue arrow highlights a classic Reid-Steinberg (RS) cell, confirming the diagnosis.

A Standing Dilemma: Autonomic Failure Preceding Hodgkin’s Lymphoma

Strange and relatively sudden symptoms in a 27-year-old man implied evidence of a rare paraneoplastic syndrome. The patient presented to the emergency department with syncope. He had been completely healthy until 6 weeks earlier when he noticed a mild sensation of lightheadedness on standing. Over the next several weeks, this was accompanied by tunnel vision, […]

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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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