No Respecter of Age -- A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a "spot" that had appeared on her right leg 3 weeks earlier

doi:10.1056/NEJMcps051960

Volume 357:1856-1859		November 1, 2007		Number 18

No Respecter of Age — A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a "spot" that had appeared on her right leg 3 weeks earlier

Don R. Martin, M.D., D. William Schlott, M.D., and John A. Flynn, M.D., M.B.A.

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In this Journal feature, information about a real patient ispresented in stages (boldface type) to an expert clinician,who responds to the information, sharing his or her reasoningwith the reader (regular type). The authors' commentary follows.

A previously healthy 65-year-old woman went to her primary carephysician in late August, seeking evaluation of a "spot" thathad appeared on her right leg 3 weeks earlier. She felt completelywell and recalled no trauma or tick bites. Her physical examinationwas notable only for a low-grade temperature elevation (37.7°C)and a 7-to-8-mm erythematous macule on her right leg. She . . . [Full Text of this Article]

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From the Divisions of General Internal Medicine (D.R.M., D.W.S., J.A.F.) and Rheumatology (D.R.M., J.A.F.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore.

Address reprint requests to Dr. Martin at the Johns Hopkins Outpatient Center, Rm. 7143, 601 N. Caroline St., Baltimore, MD 21287, or at drmartin@jhmi.edu.