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Raised nodular lesions on patient's shins at presentation.

Nodular Thyroid Dermopathy: Not a Hallmark of Graves Disease

  A 40-year-old man presented to the outpatient department with complaints of multiple, nontender, raised nodular lesions on his shins bilaterally for the past year (Figure 1). The lesions had an insidious onset and were progressively increasing in size. He was evaluated at an outside clinic. Biopsy was performed multiple times, and possibility of spindle […]

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Chest radiograph at initial presentation. Cardiomegaly and moderate left pleural effusion noted.

Drugs, the Thyroid, and the Heart: A Lethal Cocktail

A 53-year-old man was referred for evaluation of a raised international normalized ratio blood result. He had been taking warfarin and amiodarone for 2 years following a transient episode of atrial fibrillation following a percutaneous coronary interventional procedure. He was receiving treatment for severe left ventricular systolic dysfunction and type 2 diabetes mellitus (Table 1). […]

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(A) Ultrasonography of the abdomen. Intra-abdominal pancreatic cyst (7 × 8 cm) with echogenic debris. (B) Axial; (C) Sagittal images: contrast-enhanced computed tomography. Complicated pseudocyst, compression of the common bile duct, and dilated biliary tracts.

Fulminant Emphysematous Pancreatic Pseudocyst: Infected with Normal Skin Flora

A 49-year-old man was alcoholic and had major depressive disorder. He experienced epigastric pain, poor appetite, and weight loss for 1 month. Ultrasonography of the abdomen revealed a pancreatic cyst (7 × 8 cm) with echogenic debris (Figure 1A). Contrast-enhanced computed tomography (CT) of the abdomen showed a complicated pancreatic pseudocyst (Figure 1B), compressed common bile duct, […]

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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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Possible pathophysiology of thyrotoxicosis-induced vomiting.

A Grave Case of Vomiting

A 60-year-old woman presented with intractable nausea and vomiting, which had progressively intensified over the past 2 weeks. Her past medical history was remarkable for mild thrombocytopenia and mildly elevated liver enzymes. Her vomiting was triggered by oral intake, nonbloody and nonbilious, and associated with nonresolving epigastric pain, dysphagia, anorexia, and weight loss. She had […]

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A Case of Addison’s Disease Nearly Mistaken for Anorexia Nervosa

A 22-year-old woman presented to her primary care physician because of an unintentional weight loss of 30 pounds (Figure A) associated with nausea, vomiting, anorexia, and generalized abdominal pain. She also described symptoms of anxiety and low mood that coincided with the breakdown of a relationship. Although she did not report body image distortion or fear […]

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