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Right arm extensor surface (A) and left arm volar surface (C) prior to steroid therapy, depicting mottled erythema together with subcutaneous calcific deposits at the volar aspect of the upper arm, forearm, and antecubital fossa. Right arm (B) and left arm (D) after initiation of high-dose steroid therapy, showing marked improvement and resolution in erythema.

Febrile Calcinosis in Scleroderma

The collagen vascular diseases can be challenging for the internist and are associated with higher utilization of resources and less favorable outcomes among patients admitted to the inpatient medicine services.1 In this context, the acquisition of proficiency in recognizing a range of disease manifestations, common and uncommon, and familiarity with the appropriate therapeutic interventions are critical […]

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Strong Man with a Weak Heart: The Ill Effects of Performance-Enhancing Drug Use

An undisclosed habit accounted for severe left ventricular dysfunction and hepatic lesions in a young bodybuilder. A 25-year-old bodybuilder with a history of liver cysts presented with a 5-day history of epigastric discomfort, nausea, vomiting, diaphoresis, and intermittent shortness of breath. The patient was not taking any prescription medications and denied use of tobacco, alcohol, […]

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Steroid-responsive But Not Rheumatologic

An odd cluster of signs and symptoms responded to steroids, but the cause was elusive. A 75-year-old female with a history of hypertension and cerebrovascular accident presented with intermittent lethargy, fevers to 104° F (40° C), dyspnea, and a 1-week history of severe pancytopenia. Her symptoms began 4 months earlier with generalized lethargy and increasing […]

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