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NEJM—Images in Clinical Medicine

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https://www.readbyqxmd.com/read/27806222/ocular-flutter-in-the-serotonin-syndrome
#1
Shyh-Shyong Sim, Jen-Tang Sun
A 46-year-old woman was brought to the emergency department because of agitation. On arrival, she had a fever (temperature, 38.6°C) and tachycardia (heart rate, 169 beats per minute). The patient was agitated and had ocular flutter (Video 1) as well as rigidity in the legs and myoclonus in the arms..
November 3, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27806219/emphysematous-cystitis
#2
Kai-Yi Tzou, Yi-Te Chiang
A 72-year-old woman with poorly controlled hyperlipidemia and diabetes presented to the emergency department with a 5-day history of lower abdominal pain. She also had fever and reported nausea and vomiting. Physical examination revealed lower abdominal tenderness. Blood tests revealed leukocytosis..
November 3, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27783923/emphysematous-pyelonephritis
#3
Yasumitsu Hirose, Hayato Kaida
A 51-year-old man presented with fever and general malaise of 2 weeks’ duration. He had had diabetes mellitus for the preceding 20 years, and at the time of presentation this condition was poorly controlled. On admission to the hospital, his white-cell count was 10,800 per cubic millimeter (normal..
October 27, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27783915/clonus-associated-with-tropical-spastic-paraparesis
#4
Mateus S do Rosário
A 53-year-old woman with tropical spastic paraparesis (also called human T-lymphotropic virus–associated myelopathy) reported several months of worsening weakness of the legs and feet, which had led to her use of a wheelchair. On examination, she was found to have severe spasticity and weakness of..
October 27, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27797306/first-branchial-cleft-cyst
#5
Judd Fastenberg, Michel Nassar
A 3-year-old boy presented to the emergency department with pain in the right ear and swelling in the postauricular area that had begun 3 days earlier. His father reported that the boy had had a whitish discharge from his right ear 8 days earlier, for which a pediatrician had prescribed antibiotic..
October 20, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27797305/cutaneous-lupus-the-pimple-that-never-went-away
#6
Vanessa Ocampo, Shariq Haider
A 28-year-old woman presented with an erythematous rash involving the nose, nasolabial folds, and philtrum that appeared after she had manipulated a painful vesicular lesion at the base of her nose that she believed to be a pimple. The patient received cloxacillin for presumed erysipelas and had a..
October 20, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27732829/reversible-acute-mesenteric-ischemia
#7
Alexandre Nuzzo, Olivier Corcos
A 60-year-old man presented with abdominal pain and hypotension. He had recently had thrombosis of the superior mesenteric artery, which required extensive resection of the distal jejunum and ileum. His serum lactate level was 2.6 mmol per liter (normal range, 0.5 to 2.2), and his creatinine level..
October 13, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27732820/congenital-rubella
#8
Jyoti Matalia, Sheetal Shirke
An 8-month-old child was brought to pediatric ophthalmology services by his parents, who reported that he had had white opacities in both eyes and "shaky" eyes since 4 months of age. On examination, the child had wandering eye movements with bilateral central, dense, white, nuclear congenital..
October 13, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27705268/worms-in-the-eye
#9
Kyungmin Huh, Jeong Hoon Choi
A 21-year-old man presented with a 2-week history of itching in his left eye. He reported "seeing worms" in his eye. He underwent thorough irrigation of the conjunctival sac and lacrimal duct, during which three worms were removed (video and Panel A). The worms were white, slender, and filiform..
October 6, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27705250/placenta-increta
#10
Pradip Dashraath, Harvard Z Lin
A 38-year-old woman who had undergone three low-segment cesarean sections was admitted to the hospital in labor at 36 weeks of gestation. Antenatal ultrasonography suggested placenta accreta (Panel A), with the appearance of irregular vascular spaces (asterisk) and loss of retroplacental hypoechoic..
October 6, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27682055/images-in-clinical-medicine-lymphangitis-on-the-abdomen
#11
Claudia Bernárdez, David Saceda-Corralo
A 52-year-old woman presented with an erythematous and tender abdominal lesion; examination revealed a warm, indurated plaque with extension toward her left breast (Panel A). A 43-year-old man presented with a similar tender abdominal lesion; on examination, an erythematous, warm plaque with small..
September 29, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27682036/images-in-clinical-medicine-human-papillomavirus-associated-oropharyngeal-squamous-cell-carcinoma
#12
Adam L Holtzman, Kathryn Hitchcock
A 68-year-old man presented with a mass on the left side of his neck (Panel A). He had no history of tobacco use and drank one or two alcoholic drinks per week. A biopsy of the mass was performed, and histopathological examination revealed squamous-cell carcinoma that tested positive for human..
September 29, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27653591/images-in-clinical-medicine-in-vitro-exflagellation-of-plasmodium-vivax
#13
Brenno Balestra, Luisa Carnino
After recently arriving in Switzerland seeking asylum, a 24-year-old man from Eritrea presented to the emergency department with recurrent fevers. He reported having had fevers approximately every 2 months for the previous 3 years. Physical examination and routine blood tests revealed mild anemia..
September 22, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27653567/images-in-clinical-medicine-regression-of-clubbing-after-treatment-of-lung-cancer
#14
Ari J Ciment, Larry Ciment
A 59-year-old woman with a smoking history of 60 pack-years presented with progressive shortness of breath and clubbing of her fingers that had developed over a 1-year period (Panel A). A computed tomographic scan showed a large mass with cavitation in the left lower lobe of the lung (Panel B shows..
September 22, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27626541/images-in-clinical-medicine-cholesterol-embolization-after-transcatheter-aortic-valve-replacement
#15
Lu Devy, Florence Brunet-Possenti
An 88-year-old man with a history of myocardial infarction for which he had required quadruple coronary-artery bypass grafting presented with mottled-appearing purple discoloration of the skin on his toes. One month earlier, he had undergone transapical transcatheter aortic-valve replacement (TAVR)...
September 15, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27626520/images-in-clinical-medicine-urinary-tract-tuberculosis
#16
Hiromichi Masuda, Koji Kamada
A 76-year-old man with diabetes and a 2-year history of mediastinal lymphadenopathy of unknown cause presented with fever and fatigue. Pyuria was seen on urinalysis. Contrast-enhanced computed tomography (CT) of the abdomen showed mild dilatation of the left renal pelvis and thickening of the..
September 15, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27602682/images-in-clinical-medicine-generalized-granuloma-annulare-associated-with-diabetes-mellitus
#17
Menglong Ran, Yang Wang
A 64-year-old man presented with a 2-year history of asymptomatic, widespread, erythematous-to-violaceous papules that were distributed symmetrically on his trunk, arms, and legs (Panel A). The papules coalesced to form annular plaques, especially on the forearms and dorsal surfaces of the hands..
September 8, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27602670/images-in-clinical-medicine-kerion-a-boggy-lump
#18
Shraddha Uprety, Ramesh Sharma
A 13-year-old girl presented with a slowly enlarging, painful swelling of the scalp that had first been noticed 3 weeks earlier. She had received several courses of empirical oral antibiotics for suspected bacterial folliculitis and cellulitis, without improvement. On examination, there was an..
September 8, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27579660/images-in-clinical-medicine-pneumorrhachis-pneumothorax-and-subcutaneous-emphysema
#19
Christoph Straube, Martin Vazan
A 65-year-old man was admitted to the hospital to undergo adjuvant radiotherapy after having previously undergone tumor mass reduction and anterior and posterior stabilizing spinal surgery for a synovial sarcoma. On physical examination, ballooning of the right paravertebral area was noted, which..
September 1, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27579638/images-in-clinical-medicine-emphysematous-prostatitis
#20
Hsun-Shuan Wang, Ming-Chen Shih
A 42-year-old man with diabetes presented to the emergency department with severe dysuria and incontinence, which he had had for several days. Laboratory studies were notable for pyuria on urinalysis, leukocytosis (a white-cell count of 10,820 per cubic millimeter), elevated C-reactive protein..
September 1, 2016: New England Journal of Medicine
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