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Itchy papules on the back and neck of a young woman
A 19-year-old female, healthy by nature, developed viral gastroenteritis, which cleared within a few days. A month later, she developed symptoms such as thirst, polydipsia, polyuria, and weight loss. Simultaneously, itchy papules appeared on her back and shoulders. A dermatologist prescribed antihistamines as her symptoms worsened, but no improvement was observed.Endocarditis with disseminated thromboembolisms and hypercoagulable state
Ten months after radical cystectomy and adjuvant chemotherapy for an anaplastic giant cell bladder cancer (pT2N2M0), a 41-year-old woman presented with a 4-week history of intermittent claudication, lower right back pain, transient monocular vision loss, and fever.Woman in a coma
A 49-year-old woman of unremarkable past health was found comatose in her car. Blood pressure was 130/70 mmHg, pulse 80 beats per minute. There was no circumstantial evidence of drug overdose. Urine toxicology tested negative. Electrocardiography (ECG) showed anterolateral ST-segment elevation (Fig. A). Head computed tomography (CT) of demonstrated no intracranial pathology. Non-sustained ventricular tachycardia developed shortly. Echocardiography revealed left ventricular dysfunction with akinesia of mid-ventricular walls but sparing basal and apical segments (Fig. B, video).Blurred vision: Hitting the bull's eye
An 18-year-old female presented with progressive blurred vision in both eyes. On evaluation, her uncorrected visual acuity was 20/400 in both eyes. Slit lamp examination revealed bilateral supero-temporal dislocated lens splitting the pupillary axis with visible stretched zonules (Fig. 1). Intraocular pressure and posterior segment evaluation were normal. Systemic examination revealed a late systolic murmur at the apex.Acute necrosis of the corpus callosum
A 58-year-old man with a history of alcohol use disorder was admitted for apathy, confusion and aphasia of abrupt onset. In addition, clinical examination revealed a tetrapyramidal syndrome. Blood analyses showed macrocytosis, mildly elevated liver transaminase levels and hypoalbuminemia. Toxicological screening for ethanol, opiates, cannabinoids, amphetamines, cocaine, and methadone were negative. A brain magnetic resonance imaging (MRI) was performed and showed bilateral cytotoxic lesions involving the splenium of the corpus callosum depicted by T2/fluid attenuated inversion recovery (FLAIR)-weighted hyperintensities (panel A) with restricted diffusion (hypersignal on b1000 diffusion-weighted sequences and hyposignal on apparent diffusion coefficient map, panels B and C respectively) (Fig. 1).A woman with purple-brown skin lesions after immunosuppressive therapy
An 80-year-old Greek woman presented to our clinic with fatigue and new-onset skin lesions around her neck, enlarging and multiplying over the previous 6 weeks. The lesions were asymptomatic but had been causing the patient considerable embarrassment. She had no fever, chills, night sweats or weight loss. Six months earlier, she had required treatment with corticosteroids and rituximab (375 mg/m2 of body-surface area per week for 4 weeks) for severe thrombocytopenia associated with autoimmune hemolytic anemia (Evans’ syndrome).A « tipical » but rare cause of neck pain
A 34-year-old man with medical history of familial deafness presented to the emergency department for an acute left cervicalgia and painful jaw for one week. He reported a context of recent physical effort because of house moving. He had already performed a cervical echography, which showed a thickening of the wall of the left common carotid artery (panel A) without disturbance of the vascular flow on Doppler (panel B). At presentation, vital parameters were normal with symmetrical blood pressure measurement, and no fever.Not always “straight ahead” – A surprising cause of acute kidney injury
A 16-year-old girl presented with a complaint of vomiting and abdominal pain, which appreared immediately following hair straightening treatment. Her medical history was remarkable for untreated cutaneous psoriasis. She denied any use of over-the-counter medications, herbal products or illicit drugs.A red herring electrocardiogram
A gentleman in his 50s presented with atypical chest pain for the last 3 months. He had no prior comorbidities. Cardiovascular system examination was unremarkable. Baseline electrocardiogram is shown in Fig. 1A. The primary care physician labelled the electrocardiogram as ST-segment elevation myocardial infarction and advised immediate coronary angiography and intervention. The electrocardiogram was reviewed by the cardiology team, and a repeat electrocardiogram was advised, shown in Fig. 1B.Dorsal pigmentation of tongue
A 56-year-old male patient with diabetes presented with black discolouration of the tongue 7 days after extraction of two mandibular molars (Fig. 1). Prophylactic oral amoxicillin 750 mg was started a day before the extraction and was continued for 4 days after extraction. Post-extraction, because of severe pain in the socket, he did not eat properly or maintain good oral hygiene. We collected a sample from the tongue lesion and performed a cytological analysis. Fragments of filiform papillae with markedly enhanced keratinisation were observed on microscopic examination of the scraped specimen.“Milking” the way to diagnosis
A 43-year-old non-smoker man presented to the emergency department with exertional dyspnoea and left pleuritic pain lasting for 3 days. He denied fever and cough and described a history of pulmonary embolism, deep venous thrombosis and multiple opportunistic infections, namely angio-invasive pulmonary aspergillosis and pulmonary and brain Nocardia sp. Infections, the brain abscess requiring surgical excision and causing squeal epilepsy. He was chronically medicated with rivaroxaban 20 mg id, Levetiracetam 500 mg bid and co-trimoxazole 960 mg bid 3 times a week.Generalized erythematous scaly rash after glucocorticoids
A 65-years-old woman with a medical history of idiopathic thrombocytopenic purpura and psoriasis in treatment with topical glucocorticoids presented with a three-month history of burning, generalized erythematous, scaly rash, and chills. A few weeks before the rash, the patient presented petechiae on her thighs due to a low platelet count (28.000 platelets per microliter), for which she started treatment with prednisone 25 mg/week. The rash was initially treated with topical ointments including clobetasol, urea, salicylic acid, ammonium lactate, and propylene glycol without improvement.
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