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Consultant Vol 43 No 3

A network of purplish pink lesions recently developed on a 28-year-old woman’s
arms and legs. The asymptomatic rash becomes more prominent with exposure
to cold. The patient denies fever, aches, arthralgias, oral erosions, chest
pain, and photosensitivity.

Excessive belching, abdominal bloating, and flatulence caused an 89-year-old woman to seek medical attention. She reported that these previously mild and intermittent symptoms of 20 years’ duration had worsened during the last 2 years.

A 26-year-old woman complained of flatus and fecal incontinence of solid stool.
One year earlier, she was delivered of a 3.86-kg (8.5-lb) infant; a severe perineal
tear was repaired after the birth.

A 47-year-old woman who was
seropositive for HIV-1 presented to
the emergency department with severe
maculopapular, erythematous
eruptions. Her antiviral regimen had
recently been changed from zidovudine, 300 mg bid; lamivudine, 150 mg
bid; and saquinavir, 600 mg tid, to
lamivudine, 150 mg bid; stavudine, 40
mg bid; and nevirapine, 200 mg/d.

The sudden onset of a petechial rash
on the upper and lower extremities,
ecchymosis of the tongue, and an
episode of epistaxis prompted a
78-year-old woman to seek medical
evaluation. She reported having taken
one of her husband’s quinine pills a
day earlier to alleviate leg cramps.
The patient was otherwise in good
health and took no other medications.

For 2 years, an asymptomatic mass had been present in the left iliac crest area of a 6-year-old boy. The soft, rubbery, lobulated mass was not attached to the overlying skin or to the underlying structures.

The abrupt onset of widespread cutaneous eruptions prompted a 66-year-old man to seek medical evaluation. The patient had had chronic myelogenous leukemia for 5 years.

A 74-year-old man presented with generalized itching and mild jaundice. A year earlier, he had undergone a laparoscopic cholecystectomy.

This lesion on her knee had been present for 5 years, reported a 22- year-old woman. It was not related to any trauma; its size had not changed, but occasionally it became darker or lighter.

Painful cysts on the sternal and left axillary regions that had worsened over the past 3 weeks prompted a 42-year-old man to seek medical care. He reported that similar lesions in the same distribution first arose when he was 25 years old, and they recur each year. He denied having cystic acne in adolescence.

A 64-year-old man underwent a right pneumonectomy for
squamous cell carcinoma of the right lung. He was discharged
from the hospital on the fifth day after surgery.

Leprosy, or Hansen disease, had recently been diagnosed in a 39-year-old man. He presented to the tropical disease unit of Harare Hospital, Zimbabwe, for follow-up.

An otherwise healthy 38-year-old woman presented to the emergency department with a 1-day history of generalized left-sided weakness. She had no other significant medical history and was taking no medications. The patient was overweight.

A 72-year-old woman presented to the emergency department with epistaxis and generalized telangiectasia. The patient was known to have Rendu-Osler-Weber syndrome, or hereditary hemorrhagic telangiectasia, an autosomal dominant disorder that is associated with arteriovenous fistulae of many organs.

For 2 weeks, a 59-year-old woman had experienced weakness on the left side of her face. She described her appearance as "deviated" and complained of dribbling from the corner of her mouth and difficulty in chewing. The patient was unable to close her left eye and said that noises sounded unpleasantly loud and distorted in the left ear. She denied earache, vertigo, fever, headache, and rash.

Three weeks after coronary artery bypass graft (CABG)
surgery, a 52-year-old woman complained of pain at the
sternal scar. The patient had a history of diabetes and hypertension.
She had smoked cigarettes for many years.

A 47-year-old woman who was
seropositive for HIV-1 presented to
the emergency department with severe
maculopapular, erythematous
eruptions. Her antiviral regimen had
recently been changed from zidovudine,
300 mg bid; lamivudine, 150 mg
bid; and saquinavir, 600 mg tid, to
lamivudine, 150 mg bid; stavudine, 40
mg bid; and nevirapine, 200 mg/d.

The sudden onset of a petechial rash
on the upper and lower extremities,
ecchymosis of the tongue, and an
episode of epistaxis prompted a
78-year-old woman to seek medical
evaluation. She reported having taken
one of her husband’s quinine pills a
day earlier to alleviate leg cramps.
The patient was otherwise in good
health and took no other medications.

Three weeks after coronary artery bypass graft (CABG)
surgery, a 52-year-old woman complained of pain at the
sternal scar. The patient had a history of diabetes and hypertension.
She had smoked cigarettes for many years.

A 74-year-old man presented with
generalized itching and mild jaundice.
A year earlier, he had undergone a
laparoscopic cholecystectomy.

A 26-year-old woman complained of flatus and fecal incontinence of solid stool.
One year earlier, she was delivered of a 3.86-kg (8.5-lb) infant; a severe perineal
tear was repaired after the birth.

A 64-year-old man underwent a right pneumonectomy for
squamous cell carcinoma of the right lung. He was discharged
from the hospital on the fifth day after surgery.

 
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