1/10. Excessive concern with physical appearance leading to a diagnosis of adrenal adenoma.We report an unusual case of Cushing's syndrome manifested by anxiety over body image in a 26-year-old nurse. Initial presentation was a 'dermatological non-disease'. Clinical signs became increasingly evident during the course of the disease, justifying an adrenal gland evaluation which showed a secreting adrenocortical adenoma. Surgical treatment led to recovery with return to normal appearance and cessation of her aesthetic complaints. Our observation shows that persistent aesthetic complaints may sometimes reveal early hypercorticism.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. A patient with severe palindromic rheumatism and frequent episodes of pain.A 44-year-old man began to experience episodes of joint pain with erythema in his knees, elbows, shoulders, and hands in April 1996. He was diagnosed as having palindromic rheumatism. Due to the increasing frequency and severity of these episodes, he was admitted to our hospital in May 1999. Heat therapy to the affected area produced a rapid improvement in symptoms. In addition, the continued use of physical therapy during symptom-free periods tended to reduce the frequency and severity of pain attacks. We present this case and discuss treatment options in patients with palindromic rheumatism.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
3/10. Multiple herpetic whitlow lesions in a patient with chronic lymphocytic leukemia.Herpetic whitlow, a herpes simplex virus infection involving the digits, most commonly presents as a vesicular eruption involving a single digit. diagnosis of herpetic whitlow can usually be made with the history of exposure, the characteristic vesicular eruption, and a positive Tzank smear and/or viral culture. We describe a case of herpetic whitlow in a patient finishing 6 cycles of chemotherapy for refractory chronic lymphocytic leukemia that presented with a bilateral, multi-digit, crusted eruption of the hands. This is an illustrative case of an immunocompromised host status altering appearance and course of cutaneous disease such that the history and physical exam alone may not help in diagnosing atypical presentations of herpetic infections. This case underscores the necessity for clinico-histopathologic correlation.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
4/10. A case of hereditary angioedema with recurrent arthritis, erythema marginatum-like rash and chest pain.Hereditary angioedema (HAE) results from a congenital deficiency of C1 inhibitor and is characterized by submucosal and subcutaneous edema of skin, larynx and abdomen. Occasional reports have appeared linking HAE with autoimmune diseases. We report a case of HAE presenting recurrent nondeforming polyarthritis, erythema marginatum-like rash and chest pain. There were no significant radiographic joint changes. serologic tests for rheumatologic and autoimmune diseases were negative. After danazol treatment, physical examination and laboratory findings were normal over five years. We suggest that pediatricians should be aware of this rare disease and treat patients accordingly.- - - - - - - - - - ranking = 2.001601065291keywords = physical examination, physical (Clic here for more details about this article) |
5/10. Pancreatic ascites in childhood.A case is reported of pancreatic ascites in a 14-year-old girl who had acute and chronic pancreatitis associated with pancreatic duct stones and a ruptured pancreatic duct. Abdominal erythema ab igne was considered to be an important physical sign of genuine severe abdominal pain.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
6/10. Transient neonatal pustular melanosis.A Mexican-American boy presented at birth with an extensive eruption consisting of 0.5 to 1.0 cm hyperpigmented macules with a distinct peripheral scale involving primarily the forearms, abdomen and lower back (Fig. 1). Rare intact vesicopustules were also identified. There was an unremarkable prenatal history, and the infant was a product of a normal vaginal delivery. With the exception of the skin lesions and moderate hepatosplenomegaly, the physical examination was normal. Gram stains of the pustules showed numerous neutrophils but no bacteria. Bacterial cultures, of the skin and blood, TORCH screen (toxoplasmosis, rubella, cytomegalic virus, and herpes virus) and a VDRL were negative. On the second day of life, the patient developed several pustules with surrounding erythema consistent with erythema toxicum neonatorum. Wright-stained smears of these lesions showed abundant eosinophils. Hepatosplenomegaly resolved by the third day of life and at the time of discharge only hyperpigmented macules persisted. Follow-up visit six weeks later showed no evidence of skin lesions.- - - - - - - - - - ranking = 2.001601065291keywords = physical examination, physical (Clic here for more details about this article) |
7/10. tinea pedis masking a Kaposi's sarcoma.A 67-year-old white man presented with bilateral blancing erythema and scale of the second through fifth toes extending on to the dorsa and moccasin areas of the feet for two years. The right great toe had subungual debris. No cultures or KOH studies were recorded. A course of tolnaftate cream therapy was initiated. Two years later, the patient returned and complained of no change in his condition. Previously recorded descriptions and diagrams in the medical record confirmed his report. At this time, KOH preparations from the skin and nail were positive for hyphae. He refused to accept medical recommendations for a fungal culture and griseofulvin therapy. He, therefore, was instructed to use miconazole cream twice daily as alternative treatment. One year later, physical examination was unchanged. KOH preparations and fungal cultures of the skin were twice negative. A 4-mm punch skin biopsy specimen of the erythematous patch on the dorsum of the foot was performed. hematoxylin and eosin-stained sections revealed a proliferating vascular process in the cutis. Many spindle-shaped cells formed vascular slits and endothelial-lined spaces in which there were erythrocytes. No hyphae were seen. One year after the biopsy specimen was taken, the erythema of his feet persists, and a few nonblanching nodules are visible. He declined further studies.- - - - - - - - - - ranking = 2.001601065291keywords = physical examination, physical (Clic here for more details about this article) |
8/10. Mediator release in local heat urticaria.We described the sixteenth reported case of local heat urticaria, in a 59-yr-old woman with erythema and angioedema upon contact with hot water or outdoor heat exposure. Immersing her hand in 39 degrees to 40 degrees C heated water resulted in an erythematous, angioedematous response sharply demarcated by the line of immersion and was associated with immediate increases in histamine concentration (18 to 135 ng/ml) and high molecular weight neutrophil chemotactic activity (two to five times prechallenge levels) in venous blood draining the challenge site. We suggest that the local heat urticarial response in this woman was a form of physical urticaria associated with release of mast cell-derived mediators, akin to cold and cholinergic urticaria.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
9/10. methylene blue-induced phototoxicity: an unrecognized complication.OBJECTIVE. To describe photosensitization after prenatal exposure to a toxic amount of methylene blue and to alert pediatricians that, in a review of the literature, photosensitization (which this dye is capable of) has not been reported as a complication of prenatal exposure. DESIGN AND patients. A descriptive report of physical findings and significant laboratory tests in a very low birth weight preterm infant with prenatal exposure to methylene blue and a comparison of this reported case with previously described patients' complications and treatment. SETTING. Neonatal intensive care unit. INTERVENTION. Monitoring of laboratory tests to assess for methylene blue toxicity: two exchange transfusions for methemoglobinemia, hemolytic anemia, and hyperbilirubinemia; phototherapy for hyperbilirubinemia; and pathologic examination of skin bullae. RESULTS. Within hours of exposure to phototherapy, redness developed on all exposed areas of the patient's skin (which was initially deep blue), followed by bullae and desquamation of about 35% of the total skin surface area. The desquamation of erythematous areas continued even after discontinuation of phototherapy. Complete re-epithelialization was attained by 3 weeks of age. In addition to this newly observed complication, the patient had other previously described toxic effects. CONCLUSION. We have reported a previously unrecognized complication associated with high prenatal exposure to methylene blue and treatment with phototherapy. methylene blue phototoxicity may be related to the high prenatal dose of the dye relative to patient's small size and young gestational age.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
10/10. Severe, chronic anorexia and extensive leg ulcerations as presenting signs of primary sjogren's syndrome.We report the case of a 75-year-old woman with a 15-year history of inappetance resulting in weight loss of approximately 40 kg. On physical examination, the skin of the lower extremities was markedly hyperpigmented with a brown-greyish hue. In addition, the skin of the legs was infiltrated, erythematous, riddled with erosions and necrotic ulcers. Clinical and laboratory evaluation revealed sicca syndrome, a pronounced polyclonal hypergammaglobulinemia (60 g/l), high levels of antinuclear, anti-SSA and anti-SSB antibodies. Histological examination of involved skin demonstrated a leukocytoclastic vasculitis.- - - - - - - - - - ranking = 2.001601065291keywords = physical examination, physical (Clic here for more details about this article) |
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