ABSTRACT
A 47-year-old man reported becoming confused, disoriented, and anxious while driving his car. He recalled sweating and having blurred vision, palpitations, and a diffuse headache shortly before pulling to the side of the road and losing consciousness. Emergency service personnel arrived about 15 minutes later and administered a 50% solution of dextrose intravenously. On regaining consciousness, the patient had no weakness,shortness of breath, chest pain, or loss of bowel or bladder function. He had experienced a similar episode one week earlier and several others in the distant past. Each time, symptoms had been alleviated by eating.
Subject(s)
Anxiety/complications , Headache/complications , Insulinoma/diagnosis , Obesity/complications , Pancreatic Neoplasms/diagnosis , Sweating , Blood Glucose , Diagnosis, Differential , Fasting , Humans , Insulinoma/physiopathology , Insulinoma/surgery , Male , Middle Aged , Pancreatic Neoplasms/physiopathology , Pancreatic Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
A 38-year-old man presented with painful growths around his toenails. Since their first occurrence at age three, several had been surgically removed. He had had similar growths around his fingernails and multiple facial lesions since age seven.
Subject(s)
Angiofibroma/diagnosis , Angiofibroma/genetics , Facial Neoplasms/diagnosis , Facial Neoplasms/genetics , Intellectual Disability/genetics , Nail Diseases/diagnosis , Nail Diseases/genetics , Seizures/genetics , Skin Neoplasms/diagnosis , Skin Neoplasms/genetics , Tuberous Sclerosis/diagnosis , Tuberous Sclerosis/genetics , Adult , Diagnosis, Differential , Humans , MaleSubject(s)
Anesthetics, Local/adverse effects , Benzocaine/adverse effects , Cyanosis/chemically induced , Administration, Topical , Aged , Cyanosis/drug therapy , Endocarditis, Bacterial/diagnosis , Enzyme Inhibitors/therapeutic use , Humans , Male , Methemoglobinemia/chemically induced , Methylene Blue/therapeutic useSubject(s)
Dyspnea/etiology , Head , Plasmacytoma/complications , Aged , Dyspnea/therapy , Humans , Magnetic Resonance Imaging , Male , Plasmacytoma/diagnosis , Plasmacytoma/surgery , Posture , PrognosisSubject(s)
Cranial Nerve Diseases/etiology , Miller Fisher Syndrome/complications , Miller Fisher Syndrome/diagnosis , Sinusitis/complications , Antibodies, Anti-Idiotypic/blood , Chronic Disease , Diagnosis, Differential , Female , Gangliosides/immunology , Humans , Immunoglobulin E/blood , Immunoglobulins, Intravenous/therapeutic use , Miller Fisher Syndrome/blood , Miller Fisher Syndrome/therapy , Plasmapheresis , Radiography , Sinusitis/diagnostic imaging , Sinusitis/therapySubject(s)
Bacteremia/complications , Bacteremia/diagnosis , Fusobacterium Infections/complications , Fusobacterium Infections/diagnosis , Fusobacterium necrophorum , Jugular Veins , Pharyngitis/complications , Pharyngitis/diagnosis , Thrombophlebitis/diagnosis , Thrombophlebitis/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/microbiology , Clindamycin/therapeutic use , Diagnosis, Differential , Female , Fusobacterium Infections/drug therapy , Fusobacterium Infections/microbiology , Humans , Magnetic Resonance Imaging , Microbial Sensitivity Tests , Pharyngitis/drug therapy , Pharyngitis/microbiologySubject(s)
Abdominal Pain/diagnosis , Fever/diagnosis , Gastrointestinal Hemorrhage/diagnosis , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/diagnosis , Abdominal Pain/etiology , Diabetes Mellitus, Type 2/therapy , Diagnosis, Differential , Fatal Outcome , Fever/etiology , Gastrointestinal Hemorrhage/etiology , HIV-1 , Humans , Ileal Diseases/complications , Ileal Diseases/diagnosis , Male , Middle Aged , Rectum , Renal Dialysis , Tuberculosis, Gastrointestinal/complications , Tuberculosis, Gastrointestinal/diagnosisABSTRACT
A 68-year-old woman presented with generalized weakness and a rash on her lower extremities. The weakness began one week earlier, shortly after treatment for leg cramps and two days before the rash appeared. She had also had blood-streaked sputum a few days before admission. There was no history of bleeding diathesis, nose bleeding, hematuria, vasculitis, muscle or joint aches, cinchonism, or exposure to tuberculosis. She denied fever, chills, night sweats, leg pain or swelling, chest pain, or abdominal pain.
Subject(s)
Exanthema/chemically induced , Leg , Muscle Cramp/drug therapy , Muscle Relaxants, Central/adverse effects , Quinine/adverse effects , Thrombocytopenia/chemically induced , Aged , Diagnosis, Differential , Female , Humans , Platelet Count , Thrombocytopenia/diagnosisABSTRACT
A 77-year-old retired postal worker presented with symptoms of recurrent aspiration pneumonia, for which he had last been seen one month earlier. Oropharyngeal dysfunction, presumably caused by previous strokes, was demonstrated by video-esophagoscopy, and a percutaneous gastrostomy tube was placed at that time.
Subject(s)
Carcinoma, Merkel Cell/diagnosis , Pneumonia, Aspiration/complications , Skin Neoplasms/diagnosis , Aged , Carcinoma, Merkel Cell/complications , Carcinoma, Merkel Cell/mortality , Diagnosis, Differential , Humans , Male , Middle Aged , Prognosis , Skin Neoplasms/complications , Skin Neoplasms/mortalityABSTRACT
A 62-year-old man presented to the emergency department with a one-week history of subjective fever and rigors. He had had epigastric pain for three weeks, for which he was taking ranitidine, and in the past two to three months had experienced night sweats, a nonproductive cough, nausea, vomiting, and a 30-lb weight loss. He denied dsypnea, chest pain, hematochezia, melena, or any change in bowel habits.
Subject(s)
Dental Caries/complications , Fever/microbiology , Liver Abscess/complications , Shivering , Streptococcal Infections/complications , Streptococcus pyogenes , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Drainage , Humans , Liver Abscess/blood , Liver Abscess/diagnosis , Liver Abscess/microbiology , Liver Abscess/therapy , Male , Microbial Sensitivity Tests , Middle Aged , Streptococcal Infections/blood , Streptococcal Infections/diagnosis , Streptococcal Infections/microbiology , Streptococcal Infections/therapy , Suppuration , Tomography, X-Ray ComputedSubject(s)
AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/etiology , Leukoencephalopathy, Progressive Multifocal/diagnosis , Leukoencephalopathy, Progressive Multifocal/etiology , Substance Abuse, Intravenous/complications , AIDS-Related Opportunistic Infections/psychology , Diagnosis, Differential , Fatal Outcome , Humans , Leukoencephalopathy, Progressive Multifocal/psychology , Magnetic Resonance Imaging , Male , Middle AgedABSTRACT
A 47-year-old man who smelled of alcohol presented with a three-day history of sore throat. He had not had fever, nausea, vomiting, diarrhea, rhinorrhea, cough, chest pain, or palpitations. On evaluation in the emergency department, he was found to have tachycardia and an irregular pulse.
Subject(s)
Alcoholism/complications , Atrial Fibrillation/etiology , Graves Disease/complications , Graves Disease/diagnosis , Antithyroid Agents/therapeutic use , Atrial Fibrillation/diagnosis , Coxsackievirus Infections/complications , Diagnosis, Differential , Electrocardiography , Graves Disease/drug therapy , Humans , Male , Middle Aged , Propylthiouracil/therapeutic use , Thyroid Function TestsABSTRACT
An 80-year-old man presented with subjective fever, chronic cough occasionally producing scant yellow sputum, retrosternal pleuritic pain, and dyspnea on walking one block. Since symptom onset three months earlier, he had lost 20 pounds; he had had two loose stools a day, fatigue, malaise, and anorexia but not hemoptysis, nausea, vomiting, hematemesis, hematochezia, or melena. He denied paroxysmal nocturnal dyspnea or orthopnea. As far as could be ascertained, he not recently been exposed to tuberculosis or any other infectious disease. He had previously been seen at another clinic and had completed a 10-day trial of erythromycin (500 mg p.o. q12 h) without apparent change in symptoms.
Subject(s)
Acinetobacter Infections/diagnosis , Anemia/diagnosis , Pneumonia, Bacterial/diagnosis , Aged , Aged, 80 and over , Chronic Disease , Community-Acquired Infections/diagnosis , Diagnosis, Differential , Humans , Lung/diagnostic imaging , Male , Prognosis , Tomography, X-Ray ComputedABSTRACT
A 40-year-old woman who had experienced recurring episodes of dyspnea for 28 years presented to the emergency department with increasing shortness of breath, wheezing, and dry cough of three days' duration. She had been seen at another hospital shortly after symptoms began but left against medical advice. She did not have fever, chills, or other symptoms of upper respiratory infection.
Subject(s)
Dyspnea/etiology , Smoking/adverse effects , Vocal Cord Paralysis/complications , Vocal Cord Paralysis/diagnosis , Adult , Asthma/complications , Asthma/diagnosis , Diagnosis, Differential , Female , Humans , LaryngoscopyABSTRACT
A 49-year-old man presented with a five-week history of worsening confusion, agitation, and bizarre behavior. According to his mother and sister, who live with him, he had inexplicably jumped out of bed one day and complained of injuring his back. The pain apparently resolved within several days. Two weeks later, again just after awakening, he had experienced a period of confusion, lasting about 15 min. The latest episode occurred three days previously and included vivid hallucinations--at various times, he seemed to believe that he was talking to his brother on the telephone, drinking a glass of water, emptying the refrigerator, jumping into a foxhole, and stomping on rattlesnakes. He was disoriented to time as well as environment.
Subject(s)
Antipsychotic Agents/adverse effects , Chlorpromazine/adverse effects , Lithium/adverse effects , Neuroleptic Malignant Syndrome/diagnosis , Neuroleptic Malignant Syndrome/etiology , Diagnosis, Differential , Humans , Male , Middle Aged , Muscle Rigidity , Stress Disorders, Post-Traumatic , VeteransABSTRACT
MEDICAL HISTORY: Type 2 diabetes mellitus for five years; unexplained 35-lb weight loss three years ago; Bell's palsy on right side many years ago. MEDICATIONS: Glipizide, 10 mg/day. FAMILY HISTORY: Father died of leukemia at age 65; mother has kidney stones; no diabetes or neuromuscular disease. SOCIAL HISTORY: Insurance salesman; heterosexual, promiscuous, uses condoms; smokes (25 pack years); does not drink. PHYSICAL EXAMINATION: Well-nourished, well developed, not in acute distress; had difficulty rising from a sitting position because of right lower extremity weakness. Blood pressure, 154/74; pulse, 88; temperature, 36.6 degrees C; respiratory rate, 16. Head, eyes, ears, nose, and throat: normal. Neck: normal. Heart: S4. Lungs: clear. Abdomen: mildly obese. Extremities: no cyanosis, clubbing, or edema; atrophy and weakness of right thigh and both calves; wide-based gait; able to walk on toes but not heels. Neurologic responses: cranial nerves intact; deep tendon reflexes, 1 + symmetrically; plantar reflexes, flexor bilaterally. Skin: macular rash in sun-exposed areas. LABORATORY FINDINGS: Hemoglobin, 13.2 gm/dL; mean corpuscular volume, 80 micron 3; white blood cell count, 7,200/mm3 (normal differential); platelet count, 137,000/mm3. Serum: electrolytes, normal; blood urea nitrogen, 18 mg/dL; creatinine, 0.8 mg/dL; glucose, 308 mg/dL; total protein, albumin, liver enzymes, and creatine kinase, normal. Urine: 1 + glucose. Venereal disease test: nonreactive; HIV test: negative. DIFFERENTIAL DIAGNOSIS: Dermatomyositis; heavy-metal poisoning; diabetic amyotrophy. HOSPITAL COURSE: The patient was given 50 mg/day of oral amitriptyline to alleviate the painful paresthesias and was switched to 20 U/day of subcutaneously injected neutral protamine Hagedorn (NPH) insulin to normalize the blood glucose level. Histologic studies of skin and muscle showed sun damage and neuropathic changes, respectively. There was no evidence of vasculitis. Screening for heavy-metal toxins produced negative results.
Subject(s)
Diabetes Mellitus, Type 2/diagnosis , Diabetic Neuropathies/diagnosis , Muscular Diseases/diagnosis , Diagnosis, Differential , Humans , Male , Middle Aged , Muscle Weakness , Pain , Thigh , Weight LossABSTRACT
A 23-year-old man presented with fever, dyspnea, nonproductive cough, left eye redness, reduced vision, and bilateral ear pain and tenderness. The symptoms had begun two days earlier, eight days after he was discharged from the hospital with a presumptive diagnosis of Still's disease. He was first seen a month before the current admission for complaints of fever (as high as 39.4 degrees C), nonproductive cough, and asymmetric arthritis. The workup at that time included arthrocentesis of the right knee. Analysis of the joint fluid showed 7,500 white blood cells/mm3 and no crystals. A gram stain and culture of the fluid were negative. HIV and hepatitis tests, bone marrow biopsy and culture, transesophageal echocardiography, abdominal computed tomography, radionuclide bone scanning, and rheumatologic tests failed to identify the problem. The development of an evanescent macular pink rash on day 15 suggested the possibility of Still's disease. Treatment with prednisone (40 mg po qd) was initiated, and the patient was discharged on day 19.
Subject(s)
Ear, External/pathology , Polychondritis, Relapsing/diagnosis , Adult , Humans , Male , Polychondritis, Relapsing/pathology , Respiration Disorders/etiologyABSTRACT
A 72-year-old man presented with a two-week history of exertional dyspnea and nonclaudicatory pain and swelling in the right lower leg. Elevating the leg for short periods had not helped. The symptoms had begun soon after he took a nonsteroidal anti-inflammatory drug for right shoulder pain but persisted after he stopped taking the drug. His history included two-pillow orthopnea, but that had not worsened in the last year. He had not experienced chest discomfort.