Robert P. Blereau, MD

September 14, 2005

A 41-year-old man fell 3 ft into a bilge; he landed on his left leg and experienced immediate generalized pain in that knee. Three days later, he consulted his physician, who found minimal effusion in the knee and tenderness of the medial collateral ligament (MCL). No abnormalities were seen on plain x-ray films.

September 14, 2005

The mother of a 1-year-old girl observed that for 1 week her child seemed to be uncomfortable during the night and when she urinated.

September 14, 2005

After being hit on the head during a football game, a 16-year-old experienced several seconds of complete vision loss in the left eye. A few days later, he noticed the onset of blurred vision in the same eye, which progressively worsened over several weeks.

September 14, 2005

Identical circular, chocolate-colored spots developed on a 4-year-old boy's palms 2 weeks ago, according to the child's mother. The sharply demarcated, macular lesions were asymptomatic.

September 14, 2005

Encountered rarely these days, scarlet fever is believed to be caused by sensitization to an erythrogenic toxin produced by strains of group A β-hemolytic streptococci. Thus, previous exposure to the toxin is necessary for development of the rash seen here-fine, sandpaper-like, and papular on an erythematous background. It usually begins on the trunk and spreads over the entire body within hours or days. Scarlet fever is unusual in infancy, possibly because of maternal transfer of antibodies.

September 14, 2005

Large, blue-black, macular areas over the buttocks and presacral regions were present at birth in this black child. Significant hyperpigmentation of the genitals also was evident. Scrotal hyperpigmentation is not an uncommon finding in a black newborn. However, the intensity of the penile hyperpigmentation in this baby is unusual.

September 14, 2005

A new lesion recently arose on the right flexor forearm of a 67-year-old man. The 1-cm, pruritic, pink, circular, slightly raised lesion was perfectly homogeneous with no central clearing.

September 14, 2005

A 71-year-old man, who had recently returned from a month in Europe, complained of left lower leg swelling and pain of 1-week's duration. For many years, this obese patient had chronic venous insufficiency of both legs and chronic osteoarthritis of the knees that severely limited his ability to walk. The patient was admitted to the hospital with extensive cellulitis of the left lower leg.

September 14, 2005

An 11-year-old boy had generalized abdominal pain followed by nausea and vomiting. He had neither diarrhea nor fever. Examination revealed a flat, diffusely tender abdomen with no palpable masses. Pigmented macules were seen on his lips and buccal mucosa. A partial bowel resection had been performed 5 years ago because of intussusception.

September 14, 2005

Two days of pain in his right leg, which had been swollen for a week, brought this 69-year-old man with type II diabetes to the emergency department (ED). Three months earlier, the patient had undergone a radical retropubic prostatectomy with bilateral pelvic lymph node dissection. Examination in the ED revealed an edematous right leg indurated with a leathery-appearing thigh that was hot to the touch. His temperature was 38.7°C (101.7°F), and his white blood cell count was 21,290/µL with a shift to the left.