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Interstitial pneumonia with subpleural sparing and weight loss
A 36-years-old man from West Africa was admitted to our ED with respiratory failure and a 15 days history of fatigue and peevish cough. He reported watery diarrhea and a 30 kg weight loss in the last three months. In his clinical history, he did not make any recent trips abroad, nor did he reported any chronic disease, any contact with domestic or wild animals or any drug abuse. He received a complete vaccination course for SARS-CoV-2. On the physical examination we observed low-grade fever, bilateral diffused crackles on chest auscultation, latero-cervical and supra-clavicular lymphadenopathies and a maculopapular rash spread on the upper limbs and trunk.A pretibial skin lesion in a patient with type 1 diabetes mellitus
A 17-years-old woman with type 1 diabetes mellitus known since the age of 9 was admitted in the high-dependency unit for diabetic ketoacidosis. She had a history of poor glycemic control and many previous hospitalizations. Two years earlier, she reported the appearance of a red-brown, telangiectatic and hyperpigmented patch, localized in the pretibial skin of her left leg (Fig. 1). The lesion was well-circumscribed with erythema at the periphery. Two months before a spontaneous ulceration appeared in the middle of the lesion, apparently without any trauma.A diagnosis at hand
A 45-year-old man was found unconscious on the sidewalk and brought to the Emergency Department. He could not provide anamnestic information, but the hospital electronic archive revealed he was homeless and had a history of excessive alcohol consumption (250–300 g daily intake). He suffered from depressive disorder and had attempted suicide 9 years before by caustic ingestion, which led to total gastrectomy and esophagojejunal anastomosis. Physical examination revealed a Glasgow Coma Scale score of 8 with no focal neurological signs.A man with arthralgias and skin lesions
A healthy 43-year-old man presented to the Emergency Department with a one-week history of fever, low back pain and arthralgias mainly localized in the right knee. Physical examination revealed painful swelling of the left hand and lower limb (Fig. 1A), non-tender haemorrhagic macular lesions on the soles (Fig. 1B) and signs of right knee arthritis (Fig. 1C). Laboratory tests showed aspecific neutrophilic leukocytosis. A computed tomography of the lumbar region demonstrated a paravertebral mass located at L4-L5 level, which was consistent with spondylodiscitis associated with soft tissue involvement.Family rash
A healty 35-year-old woman suddenly developed a papular rash with linear disposition, involving predominantly her arms. She had no history of allergies and did not take any medication; moreover she did not complain about any other symptom.Gastrointestinal bleeding in a young male
A previously healthy 17-year-old male was admitted for pain in the right lower quadrant of the abdomen and emission of blood with stools. Abdominal angio-CT (computed tomography) was negative for active bleeding sources, esophagogastroduodenoscopy showed grade B esophagitis, two colonoscopies could not identify the source of hemorrhage. Bleeding continued during observation; hemoglobin dropped from 13 g/dl at admission at 10 g/dl at 48 h. Capsule endoscopy identified bleeding from the distal ileus.Heart of ice
A 41-year-old man was found unresponsive at home. On arrival, the air Ambulance team reported Glasgow Coma Scale 5 (E1V1M3), myosis, afinalistic movements and cold skin (28 °C). Blood glucose levels were normal. A history of recent drug and alcohol abuse was reported by friends around. Naloxone and Flumazenil administration was ineffective; intravenous fluids were administered and orotracheal intubation was performed. On admission to the hospital the vital signs were stable and the patient was quickly extubated.
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