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Hidden Giant: Medium Vessel Vasculitis as a Cause for Unresolving Fever

Thoracoabdominal Aneurysm in a Professional Body Builder

A 71-year-old man with a history of Parkinson’s disease experienced a sudden decline in function, with multiple falls over 2 weeks. He had previously been able to ambulate independently but had become chair-bound over this period. Forty-eight hours into admission he was noted to be spiking fevers of 38°C-39°C daily, without chills or rigors. There […]

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Transthoracic echocardiogram views revealing collapse of the right atrium during atrial diastole (red arrowheads) and of the right ventricle during ventricular diastole (red arrows).

Cardiac Tamponade: An Unusual Presentation of Systemic Lupus Erythematosus

A 55-year-old Ghanaian man was admitted to our service with 4 days of acute, progressive dyspnea. He developed orthopnea the night prior to his admission. Review of systems revealed progressive asthenia, anorexia, and low-grade fever for the past few months, with an unintentional weight loss of approximately 40 lbs. No other symptoms were elicited. The […]

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young female doctor examines x-ray

A Depressing Diagnostic Error

To the Editor: A 52-year-old woman with diabetes presented to the hospital with acute onset of right flank pain, in the setting of profound lower extremity weakness and cachexia with a 30-lb unintentional weight loss over the past 6 months. She was diagnosed with ascending pyelonephritis and treated with empiric antibiotics. On hospital day 2, […]

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(A) Computed tomography of the abdomen/pelvis revealed a low attenuating lesion within the right lobe of the liver measuring 5.2 × 5.0 × 5.8 cm and (B) mild pericolonic fat stranding in the sigmoid colon. (C) An abdominal ultrasound scan revealed a 5.6-cm hyperechoic area in the central liver and (D) a thick-walled gallbladder filled with stones. (E) A sonographically guided percutaneous catheter drain was placed into the right liver abscess.

Unusual Case of Fever and Abdominal Pain

Pyogenic liver abscess is an uncommon type of intra-abdominal abscess and occurs in approximately 3.6 per 100,000 hospitalized individuals.1 The incidence of pyogenic liver abscess is increasing.1 Here we present a case of Streptococcus anginosus liver abscess, secondary to acute uncomplicated sigmoid diverticulitis and acute cholecystitis. Case Report A 63-year-old man presented to our tertiary medical center with a […]

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The patient had multiple telangiectasias. (A) These were evident on the fingertips. (B) The oral mucosa was also affected.

Site-Seeing: Hereditary Hemorrhagic Telangiectasia with Native-Valve Endocarditis

A 69-year-old Japanese man had 2 disparate illnesses with a comparable sign. The first, an undiagnosed genetic disease, made him more susceptible to the second. He was admitted to our hospital after reporting a 1-month history of chills, malaise, anorexia, pain in the left knee, and blurred vision in the right eye. He denied urinary […]

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A bubble study was performed with transesophageal echocardiography. (A) This image was obtained before the bubble study. (B) In the early phase of the bubble study, bubbles (arrow) moved from the right atrium (RA) to the left atrium (LA) through the interatrial septum (IAS). (C) In the late phase of the bubble study, bubbles (arrows) were located in the right atrium. (D) This image was captured after percutaneous closure of the interatrial septum (star).

Falls and Delirium: Platypnea-Orthodeoxia Syndrome

An 85-year-old woman’s inability to remain standing was ultimately connected to an undiagnosed congenital defect. The patient was admitted to the geriatric unit of a university hospital for new frequent falls and subacute delirium, both of which began 1 month before presentation. Her medical history included ischemic stroke 10 years earlier, mild neurocognitive impairment, and […]

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