A 26-year-old white male aviator presents to his primary care physician for
his annual military physical examination. The patient is healthy, takes no
medications, and has no history of serious medical disorders. Genital examination reveals multifocal, confluent, slightly variegated,
hyperpigmented macules with irregular borders located in a circumferential
distribution on the penile shaft and glans.
A 37-year-old man presented to the emergency department with painful, burning,
blistering skin lesions. The lesions started 3 days earlier on the face and
spread to the trunk and extremities. Ten days before presentation, the patient had
received a diagnosis of AIDS.
For several years, an asymptomatic mass had been growing on the
neck of a 54-year-old-man. Physical examination revealed a firm,
nontender mass located slightly left of midline at the level of the hyoid
A previously healthy 55-year-old woman complained of fever, weakness, and generalized malaise for the past 3 to 4 weeks. She had been treated with ciprofloxacin, amoxicillin, and azithromycin for 21 days with no resolution of her symptoms. Five days before she was hospitalized, multiple nonspecific constitutional complaints developed.
During an interval examination, a new pulsatile mass is detected slightly
above the umbilicus of a 72-year-old man with chronic obstructive pulmonary
disease (COPD). He has not noticed any abdominal pain or any other
The diagnosis of many serious infectious
diseases relies heavily on clinical
suspicion, particularly in the early
stages of the illness. In this 3-part series,
we provide useful clues to the
triage and diagnosis of these diseases. Here we discuss staphylococcal
toxic shock syndrome (TSS) and
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