A 38-year-old man had fever and fatigue for the past 6 days and tenderness in the left upper abdominal quadrant for the past 3 days. He also had a facial butterfly rash that had been present for 10 years and a 1-year history of lupus nephritis, treated with prednisone and mycophenolate. More »

This rash on the face and neck of a 27-year-old man appeared periodically over a 2-month period. During this time, the patient’s work involved welding inside a steel oil tank. More »

A 26-year-old woman at 30 weeks’ gestation presented to the emergency department with a throbbing frontal headache of 1 month’s duration. She had also had peripheral blurred vision for the past 2 weeks. More »

Several days earlier, a 69-year-old man had a mild headache, fatigue, and tingling and prickly facial sensations. Shortly afterward, this painful, “weepy” rash developed on his forehead, upper cheek, and nasolabial folds and vision in the right eye became blurry. The patient’s history included type 2 diabetes mellitus, hypertension, and childhood varicella. More »

For 10 days, a 55-year-old man had a productive cough and progressively worsening rightsided chest pain that was sharp, nonexertional, and worse with deep inspiration and movement. He denied hemoptysis, fevers, sick contacts, or recent travel. More »

This dark maroon, cystic, dome-shaped, 8-mm lesion on a 75-year-old man’s back had been present for 2 years (A). It would occasionally bleed after minor trauma, such as when the patient dried his back with a bath towel. He had no history of skin cancer. More »

The multiple, symmetrically distributed, soft, nontender swellings on the shoulders and torso of a 56-year-old Hispanic man are characteristic of multiple symmetric lipomatosis (MSL), also known as Madelung disease or Launois- Bensaude syndrome. More »

For several months, a 43-yearold woman had erythematous plaques on the cheeks that were more prominent on the right side. The patient had no pruritus but reported occasional facial burning. She had tried overthe- counter lotions but no medicated or corticosteroid topical preparations. She was otherwise healthy and was currently taking no medications. More »

A 60-year-old woman with a 3-month history of progressively worsening epigastric pain was referred for elective cholecystectomy after ultrasonography showed findings consistent with chronic cholecystitis (A and B). The patient reported having postprandial abdominal discomfort since 4 years of age. She also had occasional nausea and vomiting but denied jaundice, change in bowel habits,... More »

A 70-year-old woman with poorly controlled type 2 diabetes mellitus (hemoglobin A1c, 12.5%) and hypertension was brought to the emergency department for evaluation of abdominal pain and loose bowel movements. More »

A 24-year-old man was concerned about the small “bumps” on his abdomen that had been increasing in number over the past several years. They were asymptomatic. The patient denied a family history of similar lesions. More »

Progressively worsening nasal congestion and headaches with diplopia and left proptosis for 2 months prompted an ophthalmology consultation for a 67-year-old woman. More »

For a month, an obese 50-year-old woman with type 2 diabetes mellitus, hypercholesterolemia, and hypertension had blurry vision in both eyes. During this time, she also had ataxia and right-sided numbness. For the past 2 days, she had had horizontal, binocular diplopia with right gaze. More »

A 59-year-old man presented with painful paraparesis of acute onset, severe low back pain, and shortness of breath. On initial examination, he had 0/5 strength and numbness in his lower extremities. The skin from below his umbilicus to his lower legs was pale. More »

A 61–year–old man presented to the emergency department with diffuse lower abdominal pain, nausea, and severe diarrhea (20 episodes within the past 12 hours). His symptoms began the night before and had gradually worsened. He denied fever. His medical history was significant for hypertension. More »

The purple-stained urine bags and tubing of 2 elderly patients are shown here. Neither patient received urine-discoloring medications. After a urinary catheter was placed in an 85-year-old woman who was receiving hospice care, purple discoloration of the tubing and the urine bag developed. More »

A 77-year-old woman with hypertension, diabetes mellitus with neuropathy and nephropathy, coronary artery disease, and previous stroke with residual right hemiparesis was hospitalized because of abdominal pain, nausea, and vomiting of sudden onset. More »

For 2 weeks, a 52-year-old man had progressive fatigue and myalgias. On the morning of presentation, he could not walk. More »

This white patch in the medial periorbital area of a 15-year-old girl had been present for several months. It was asymptomatic. The patient denied having had an injury to the area. More »

Palpitations and dizziness prompted a previously healthy 21-year-old cable lineman from southeastern Pennsylvania to seek medical attention. An ECG showed first-degree heart block. The young man was scheduled for outpatient cardiology consultation, but his symptoms worsened and he presented to an emergency department with chest... More »