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Correspondence
Vemurafenib Sensitivity Skin Reaction after Ipilimumab
To the Editor: Ipilimumab, and vemurafenib each improve the overall survival of patients with metastatic melanoma. Ipilimumab was approved by the Food and Drug Administration in March 2011; vemurafenib was approved 5 months later. As a result, patients with disease progression during treatment with…
- March 1, 2012
- N Engl J Med 2012; 366:866-868
- Free Full Text
Patients with melanoma who have received ipilimumab appear to be at an increased risk for a drug-hypersensitivity rash when treated with vemurafenib.
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Correspondence
Ultraviolet A and Photosensitivity during Vemurafenib Therapy
To the Editor: Vemurafenib (PLX4032, Zelboraf) is a selective inhibitor of V600E BRAF. In phase 1, 2, and 3 clinical trials involving patients with tumors that have V600E BRAF mutations, vemurafenib was associated with consistent efficacy and improved survival. These data led to approval of…
- February 2, 2012
- N Engl J Med 2012; 366:480-481
- Free Full Text
The BRAF inhibitor, vemurafenib, is associated with photosensitivity. This small study identifies ultraviolet A (UVA) as the active agent. UVA blockers may be effective in preventing photosensitivity among patients taking vemurafenib.
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Images in Clinical Medicine
Chemotherapy-Induced Hyperpigmentation of the Tongue
Figure 1.
- September 8, 2011
- Blaya M. and Saba N.
- N Engl J Med 2011; 365:e20
- Free Full Text
After undergoing breast lumpectomy and biopsy of the sentinel lymph nodes, a 42-year-old woman with invasive ductal carcinoma began adjuvant chemotherapy. After the second cycle, asymptomatic hyperpigmented macules and patches were noted on the patient's tongue.
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Images in Clinical Medicine
Fixed Drug Eruption
Figure 1.
- August 11, 2011
- Valente Duarte de Sousa I.C.
- N Engl J Med 2011; 365:e12
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A 35-year-old man presented with a 10-day history of a cutaneous lesion on the left anterior chest. Examination revealed an annular, scaly, blistering, violaceous plaque, 5 cm in diameter, with an erythematous periphery. The lesion had appeared 24 hours ...
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Images in Clinical Medicine
Angioedema
Figure 1.
- July 14, 2011
- Bramante R.M. and Rand M.
- N Engl J Med 2011; 365:e4
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A 71-year-old man presented to the ER with rapidly progressive tongue swelling. Examination revealed a swollen tongue and no hypotension, rash, bronchospasm, urticaria, or flushing. The patient had no recent exposures to known food allergens, new medications, or insect stings.
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Images in Clinical Medicine
Toxic Effects of Levamisole in a Cocaine User
Figure 1.
- June 16, 2011
- Muirhead T.T. and Eide M.J.
- N Engl J Med 2011; 364:e52
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A 54-year-old woman presented with a 2-day history of a painful, enlarging rash over her face (Panel A), ears (Panel B), breasts, and extremities. Laboratory studies revealed neutropenia (neutrophil count, 1070 per cubic millimeter) and lymphopenia (...
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Original Article
Carbamazepine-Induced Toxic Effects and HLA-B*1502 Screening in Taiwan
The Stevens–Johnson syndrome (SJS) and its related disease, toxic epidermal necrolysis (TEN), are two of the most serious adverse reactions caused by drugs. SJS is characterized by high fever, malaise, and a rapidly developing, blistering exanthema of macular papules and target-like lesions,…
- March 24, 2011
- Chen P., Lin J.-J., Lu C.-S., et al.
- N Engl J Med 2011; 364:1126-1133
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In this prospective study, Han Chinese subjects who were candidates for carbamazepine therapy were screened for the HLA-B*1502 allele because of its association with the Stevens–Johnson syndrome and toxic epidermal necrolysis.
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Original Article
HLA-A*3101 and Carbamazepine-Induced Hypersensitivity Reactions in Europeans
Carbamazepine is one of the most commonly prescribed drugs for the treatment of epilepsy, as well as trigeminal neuralgia and bipolar disorder. A minority of treated persons have hypersensitivity reactions that vary in prevalence and severity, with some forms associated with substantial morbidity…
- March 24, 2011
- McCormack M., Alfirevic A., Bourgeois S., et al.
- N Engl J Med 2011; 364:1134-1143
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A strong association between the HLA-B*1502 allele and SJS and TEN induced by carbamazepine has been shown. This study involving Europeans implicates a different HLA allele, HLA-A*3101, in conferring susceptibility to a broad range of carbamazepine-induced reactions.
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Case Records of the Massachusetts General Hospital
Case 7-2011 — A 52-Year-Old Man with Upper Respiratory Symptoms and Low Oxygen Saturation Levels
Presentation of Case. Dr. Roby P. Bhattacharyya (Medicine): A 52-year-old man was seen in the urgent care outpatient medical clinic at this hospital because of upper respiratory symptoms. The patient had been in his usual state of health until 3 days earlier, when subjective fever, fatigue,…
- March 10, 2011
- Pallais J.C., Mackool B.T., Pitman M.B.
- N Engl J Med 2011; 364:957-966
A 52-year-old man had low oxygen saturation by pulse oximetry, without other evidence of hypoxemia. He had dermatitis herpetiformis, treated with dapsone, and type 1 diabetes mellitus, with normal hemoglobin A_1c levels despite poor glycemic control. A diagnostic test was performed.
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Clinical Therapeutics
Treatment of Non–Small-Cell Lung Cancer with Erlotinib or Gefitinib
Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…
- March 10, 2011
- Cataldo V.D., Gibbons D.L., Pérez-Soler R., Quintás-Cardama A.
- N Engl J Med 2011; 364:947-955
- CME
A 64-year-old woman receives the diagnosis of metastatic non–small-cell lung cancer (NSCLC), which has progressed during treatment with carboplatin, paclitaxel, and bevacizumab. Erlotinib therapy is recommended.
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Images in Clinical Medicine
Palmar–Plantar Rash with Cytarabine Therapy
Figure 1.
- January 20, 2011
- Rosenbeck L. and Kiel P.J.
- N Engl J Med 2011; 364:e5
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A 52-year-old man with acute myeloid leukemia underwent induction chemotherapy consisting of a 7-day intravenous infusion of cytarabine plus daunorubicin on days 1 through 3. Bone marrow biopsy performed on day 14 revealed that blast cells still accounted ...
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Images in Clinical Medicine
Bleomycin-Induced Flagellate Hyperpigmentation
Figure 1.
- December 9, 2010
- Ibrahimi O.A. and Anderson R.R.
- N Engl J Med 2010; 363:e36
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A 39-year-old woman with a long-standing vascular malformation of the posterior tongue underwent intralesional sclerotherapy with a single dose of bleomycin. Within 1 week after treatment, painless, nonpruritic, flagellate hyperpigmentation developed on ...
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Images in Clinical Medicine
Serpentine Supravenous Hyperpigmentation
Figure 1.
- July 29, 2010
- Chan C.-C. and Lin S.-J.
- N Engl J Med 2010; 363:e8
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A 61-year-old man with recently diagnosed, inoperable esophageal squamous-cell carcinoma was treated with induction chemotherapy combining cisplatin and fluorouracil and concurrent radiotherapy. Because of worsening renal function, the use of cisplatin ...
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Correspondence
Aprepitant for Erlotinib-Induced Pruritus
To the Editor: Aprepitant is the first commercially available drug of a new class of neurokinin-1–receptor antagonists for treating chemotherapy-induced nausea and vomiting. The dominant ligand for the neurokinin-1 receptor is substance P. An increase in the number of neurokinin-1 receptors on…
- July 22, 2010
- N Engl J Med 2010; 363:397-398
- Free Full Text
To the Editor: Aprepitant is the first commercially available drug of a new class of neurokinin-1–receptor antagonists for treating chemotherapy-induced nausea and vomiting. The dominant ligand for the neurokinin-1 receptor is substance P.¹,² An increase ...
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Images in Clinical Medicine
Chloroquine-Induced Hair Hypopigmentation
Figure 1.
- July 22, 2010
- Donovan J.C. and Price V.H.
- N Engl J Med 2010; 363:372
- Free Full Text
A 16-year-old, blonde-haired patient was evaluated for a new band of lighter-colored hair located approximately 3 cm from the scalp. The patient first noted the change in hair color 1 week after returning from a 2-week vacation in Costa Rica, during which ...
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Images in Clinical Medicine
Multiple Beau's Lines
Figure 1.
- May 20, 2010
- Park J. and Li K.
- N Engl J Med 2010; 362:e63
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A 69-year-old man was referred for the evaluation of changes to his fingernails after the initiation of chemotherapy for gastric cancer.
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Review Article
Current Concepts: Bacterial Infections in Drug Users
Illicit drug use is a worldwide health problem. Annually, Approximately 5 percent of the global population, or 200 million people, use illicit drugs. In a U.S. survey, 19.5 million people 12 years of age or older, or 8.2 percent of the population, had used an illicit drug in the prior month.…
- November 3, 2005
- Gordon R.J. and Lowy F.D.
- N Engl J Med 2005; 353:1945-1954
There are an estimated 13 million injection-drug users worldwide, and infections are among the most serious complications of drug use. This article reviews the common problems associated with drug use, including skin and soft-tissue infections, septic arthritis, osteomyelitis, and endovascular infections. The authors describe the most common organisms and provide guidance on both treatment and prevention.
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Images in Clinical Medicine
Amiodarone-Induced Skin Discoloration
Figure 1.
- December 18, 1997
- Sivaram C.A. and Beckman K.J.
- N Engl J Med 1997; 337:1813
- Free Full Text
Figure 1. A 61-year-old man who had had a defibrillator implanted after a cardiac arrest in 1989 was treated with amiodarone in 1990 because of frequent shocks from the defibrillator. After an initial loading dose, a maintenance dose of 400 mg daily was ...
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Medical Progress
Surgery of the Hand
Vascular Trauma. Conservative treatment of arterial injuries advocated in the past can no longer be justified. When the injury is associated with sensory or motor loss, pallor or coolness, lack of pulses, the extremity must be considered for exploration with arteriography in the operating room as…
- December 14, 1972
- Chase R.A.
- N Engl J Med 1972; 287:1227-1234
Vascular Trauma¹¹⁰

Conservative treatment of arterial injuries advocated in the past can no longer be justified.¹¹¹ When the injury is associated with sensory or motor loss, pallor or coolness, lack of pulses, the extremity must be considered for ...
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Original Article
Marihuana Smoking — Cardiovascular Effects in Man and Possible Mechanisms
THE only invariable objective measurable change hitherto recorded after marihuana smoking in man is tachycardia; there are few data concerning other cardiovascular responses to cannabis and, in particular, no information about its influence on peripheral blood flow. This lack of information is all…
- August 3, 1972
- Beaconsfield P., Ginsburg J., Rainsbury R.
- N Engl J Med 1972; 287:209-212
THE only invariable objective measurable change hitherto recorded after marihuana smoking in man is tachycardia; there are few data concerning other cardiovascular responses to cannabis and, in particular, no information about its influence on peripheral ...
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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