What's Your Diagnosis

What is this fingernail condition called—-and what do you suspect is the likely cause?

This rounded 0.5 cm ulcerated lesion with a slightly raised border between the helix and the antihelix had been present on an 85-year-old man’s ear for an unknown period.

A woman in her 20’s presents for care after 9 days of sore throat and subjective fevers followed by neck stiffness that developed over the last 2 to 3 days. The pain is exacerbated by swallowing and any neck motion. She has had sore throats before, but never this bad or this long and never that made her neck stiff.

A 46-year-old man with history of diabetes, hypertension, and renal failure presented with high fever, dyspnea on exertion, and pleuritic chest pain. Two weeks earlier, a dialysis catheter had been placed to initiate emergency hemodialysis. Is there a connection to be made here?

A 30-year-old man presented with multiple, mildly pruritic, nonpainful scrotal lesions of 3 months’ duration. He reported a history of similar lesions on 2 occasions, which were removed surgically in another country.

A 5-month-old girl with progressively worsening generalized rash of 3 weeks’ duration. No obvious sensitivity, fever, recent infection, medication use, or known contact with irritant.

Four-month-old Hispanic boy brought for evaluation because of hypopigmented patches on his skin and a history of seizures. Infant was the product of an uncomplicated pregnancy; born at 40 weeks' gestation to a 16-year-old gravida 1, para 1 mother who received appropriate prenatal care. At birth, he had multiple hypopigmented patches on his face, torso, and extremities. At age 2 months, he was hospitalized for new-onset seizures.

Twenty-two-month-old girl seen in the emergency department (ED) after several hours of abdominal pain associated with non-bloody, non-bilious emesis. Over past 2 months, has had 7 or 8 similar episodes of abdominal pain followed by emesis 1 to 2 hours later.