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Magnetic resonance cholangiopancreatography demonstrating small filling defects in the distal common bile duct.

A Simpler Answer – After All This Time

There is an allure associated with a rare diagnosis. Diagnosis momentum refers to the “stickiness” of a diagnosis once it is attached to the patient,1 and is one example of a cognitive bias that can lead to diagnostic errors. This can lead to misattribution of symptoms to a patient’s existing (even incorrect) diagnosis if clinicians do […]

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Brainstem miliary pattern on admission.

CLIPPERS: An Increasingly Recognized Chronic Inflammatory Central Nervous System Disorder

Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS) is a rare chronic inflammatory neurological syndrome affecting multiple regions of the brain, including brainstem, cerebellum, and spinal cord, that has become increasingly recognized since its introduction in 2010 by Pittock et al.1 The hallmark neuroimaging finding for CLIPPERS consists of multiple punctate, curvilinear lesions, […]

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Computed tomography of the neck.

An Overlooked Cause of Polyuria

A 40-year-old woman presented to the Outpatient Department with complaints of frequent urination and excessive thirst for 3 months. She was passing large volumes of urine throughout the day and night, but she denied dysuria, urgency, or hesitancy. She used to consume 2 cups of tea in a day. Twenty-four-hour urine output was 6 L, […]

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(A and B) Large eschars on bilateral medial thighs with mild erythema; corresponding plain radiographs with vascular and soft tissue calcifications are shown in the inset. (C) 99mTc-sestamibi parathyroid scintigraphy demonstrating hypermetabolic activity posterior to the superior pole of the right thyroid lobe suggestive of parathyroid adenoma.

Classic Lesion, Not-So-Classic Cause

Calciphylaxis (also known as calcific uremic arteriolopathy) is a serious disorder characterized by skin necrosis secondary to reduction in the blood flow caused by calcification, fibrosis, and thrombus formation in the dermohypodermic arterioles. While calcific uremic arteriolopathy has been reported in nonuremic patients, it is primarily observed in patients with end-stage renal disease, especially those […]

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A Bad Sign: Dermatomyositis with Interstitial Lung Disease

The presence of an autoantibody explained why a patient with dermatomyositis had respiratory symptoms. A 52-year-old man presented with a 1-month history of fever and rash, and a 2-week history of muscle pain and muscle weakness, which made it difficult for him to rise from a sitting position. The patient denied being a smoker or […]

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Hematoxylin-eosin stain showing patchy perivascular and interstitial granulomas (original magnification, 40×).

Sarcoidosis Presenting as Isolated Anasarca and Hypercalcemia

A 62-year-old woman presented to clinic for a second evaluation. Previously healthy, she initially presented for care several months earlier with anasarca. Initial workup was notable for normal renal function, calcium level, and liver function tests, no proteinuria, and echocardiogram demonstrating mild diastolic dysfunction and concentric left ventricular hypertrophy but preserved systolic function. One month […]

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