Photoclinic

For 10 weeks, a 34-year-old woman had refractory sinusitis, epistaxis, painful sores in her mouth with erosions in the nasal cartilage and palate, and otitis media in the left ear.

An 18-year-old woman from Mexico was hospitalized because of severe headache with nausea and vomiting. Her headaches had started 4 years earlier and had progressively worsened. They occurred mainly in the occipital region and were pulsating, worse on bending down, and unrelieved by any medication. They were often accompanied by dizziness and presyncope.

These pruritic pustules had appeared on the lower back of a 45-year-old white man and progressively spread to the entire back over a month. He had recently completed chemotherapy for chronic lymphocytic leukemia. Results of HIV testing were negative.

For about 2 weeks, a 61-year-old woman with diet-controlled diabetes and hypertension had fatigue and generalized weakness. For the past 3 months, she had had poorly localized back pain and bilateral flank pain. She denied dysuria, fever, decreased urinary output, or weight loss.

Intensely pruritic lesions of acute onset are evident on the legs of a 24-year-old woman who had no history of similar episodes. She was in excellent health and took no medications. She had spent the previous evening seated outdoors at a restaurant.

A15-year-old girl was referred to a pediatric endocrinologist for evaluation of hyperthyroidism. Her primary concerns were intermittent increases in heart rate and appetite (with a weight gain of 7 kg within the past year), feeling hot at night even in winter, persistent lower extremity edema that had been present since age 4 years, and difficulty in concentrating. She denied having diarrhea, sweating, fatigue, breathing difficulties, hair loss, or changes in hair texture.

For 3 days, a 7-year-old girl had severe, generalized abdominal pain. The patient described the pain as sharp and achy without radiation; she denied any relieving or aggravating factors. She also reported decreased appetite and energy for the past week.

The rash on this 4-week-old girl had appeared 5 days earlier on her face as thickened scales on an erythematous base and subsequently spread to the scalp, shoulder, chest, abdomen, and extremities. A few bullae were noted on the neck and hands. Initial treatment with cephalexin failed to control the rash, and the infant was admitted to the hospital for further evaluation.

A 16-year-old girl with internal jugular phlebectasia presented for followup ultrasound evaluation. At age 15 months, she was noted to have a right-sided neck mass that appeared when crying or straining. Her weight, height, and head circumference were normal. She had no cardiac anomalies and was otherwise healthy.

During hospitalization of a 6-month-old boy for respiratory syncytial virus infection, spiking fevers led to a bacteremia workup.