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  • Images in Clinical Medicine

    Kerion Celsi

    Figure 1.

    • March 22, 2012
    • Proudfoot L.E. and Morris-Jones R.
    • N Engl J Med 2012; 366:1142
    • Free Full Text

    A healthy 5-year-old boy presented with a 3-month history of an inflammatory mass on the scalp that had not responded to antibiotics. The physical examination revealed a boggy occipital swelling studded with pustules, as well as postauricular lymphadenopathy.

  • Case Records of the Massachusetts General Hospital

    Case 2-2012 — A 63-Year-Old Woman with Dyspnea and Rapidly Progressive Respiratory Failure

    Presentation of Case. Dr. Susan K. Mathai (Internal Medicine): A 63-year-old woman was admitted to this hospital because of rapidly progressive respiratory failure. The patient had a history of Poland syndrome (agenesis of the right breast, pectoralis muscle, and the third and fourth costal…

    • January 19, 2012
    • Kotton D.N., Muse V.V., Nishino M.
    • N Engl J Med 2012; 366:259-269

      A 63-year-old woman was admitted to the hospital because of respiratory failure. She had a history of granulomatous polyangiitis and a breast implant that had recently become painful. Imaging revealed bilateral pulmonary infiltrates and a soft-tissue mass extending from the implant through the chest wall.

    • Clinical Problem-Solving

      A Bird's-Eye View of Fever

      Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 78-year-old man presented to his…

      • November 3, 2011
      • Lee A.I., Koo S., Vaidya A., Katz J.T., Loscalzo J.
      • N Engl J Med 2011; 365:1727-1732

        A 78-year-old man presented with a 4-month history of worsening fatigue, weakness, and anorexia, with an unintentional weight loss of 11.4 kg. He reported fevers, chills, night sweats, dry mouth, nonproductive cough, dyspnea with minimal exertion, nausea, and postural light-headedness.

      • Case Records of the Massachusetts General Hospital

        Case 28-2011 — A 74-Year-Old Man with Pemphigus Vulgaris and Lung Nodules

        Presentation of Case. Dr. Omobolaji T. Campbell (Infectious Diseases): A 74-year-old man was seen in the surgery clinic at this hospital for evaluation of lung nodules. A diagnosis of pemphigus vulgaris had been made 5 months earlier after a 2-month history of skin lesions that had progressed from…

        • September 15, 2011
        • Mylonakis E., Muse V.V., Mino-Kenudson M.
        • N Engl J Med 2011; 365:1043-1050
        • CME

        A 74-year-old man with pemphigus vulgaris was referred to this hospital for evaluation of lung nodules. Imaging of the chest revealed multiple ill-defined nodules, some with marked 18F-fluorodeoxyglucose avidity. A diagnostic procedure was performed.

      • Original Article

        STAT1 Mutations in Autosomal Dominant Chronic Mucocutaneous Candidiasis

        Chronic mucocutaneous candidiasis (CMC) is a primary immunodeficiency disorder that is characterized by susceptibility to infection of the skin, nails, and mucous membranes by candida species and dermatophytes. There are several CMC subtypes: autosomal recessive autoimmune polyendocrinopathy…

        • July 7, 2011
        • van de Veerdonk F.L., Plantinga T.S., Hoischen A., et al.
        • N Engl J Med 2011; 365:54-61
        • Free Full Text

        Autosomal dominant chronic mucocutaneous candidiasis (CMC) is a severe immunodeficiency characterized by mucosal infections with fungi. Mutations affecting a particular region of the STAT1 signaling protein cause autosomal dominant CMC, probably through denting of the responses of type 1 and type 17 helper T cells.

      • Clinical Problem-Solving

        A Recurrent Problem

        Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 50-year-old woman from Texas had…

        • June 2, 2011
        • Vikram H.R., Dhaliwal G., Saint S., Simpson C.B.
        • N Engl J Med 2011; 364:2148-2154
        • CME
        • Video

        A 50-year-old woman from Texas had nasal stuffiness, postnasal drip, myalgias, cough, and hoarseness in early winter. Six weeks later, her nonproductive cough and hoarseness persisted. She had no fever, chills, night sweats, pain, weight loss, nausea, vomiting, or rash.

      • Case Records of the Massachusetts General Hospital

        Case 10-2011 — A Woman with Fever, Confusion, Liver Failure, Anemia, and Thrombocytopenia

        Presentation of Case. Dr. Andrea L. Russo (Medicine): A 60-year-old woman was admitted to this hospital because of fever, confusion, liver failure, anemia, and thrombocytopenia. The patient had been in her usual state of health, with a history of hepatitis C virus infection and cirrhosis, until 2…

        • March 31, 2011
        • Tierney L.M., Thabet A., Nishino H.
        • N Engl J Med 2011; 364:1259-1270

          A 60-year-old woman was admitted to the hospital with confusion, fever, liver failure, anemia, and thrombocytopenia. She had recently begun treatment for hepatitis C. Serum levels of ferritin and triglycerides were elevated. A diagnostic procedure was performed.

        • Original Article

          Exposure to Environmental Microorganisms and Childhood Asthma

          Environmental exposure to microorganisms has repeatedly been found to be inversely related to the manifestation of atopic diseases such as asthma and hay fever. This observation has been made in various contexts, including the studies conducted in the Republic of Karelia (Russia) and North Karelia (…

          • February 24, 2011
          • Ege M.J., Mayer M., Normand A.-C., et al.
          • N Engl J Med 2011; 364:701-709
          • Free Full Text

          Growing up on a farm protects children from asthma. In this study, the investigators show that the diversity of microbial exposure of farm children as compared with children in the reference group can explain the observed protective effect.

        • Editorial

          Barnyard Microbes and Childhood Asthma

          It is easy to imagine why children who are raised on farms might grow up healthy: there is plenty of fresh air, exercise, and exposure to sunlight. In fact, studies from Europe, North America, and Australasia provide convincing evidence that allergic diseases and asthma are less likely to develop…

          • February 24, 2011
          • Gern J.E.
          • N Engl J Med 2011; 364:769-770

            It is easy to imagine why children who are raised on farms might grow up healthy: there is plenty of fresh air, exercise, and exposure to sunlight. In fact, studies from Europe, North America, and Australasia provide convincing evidence that allergic ...

          • Images in Clinical Medicine

            Fungal Infection from Sweeping in the Wrong Place

            Figure 1.

            • January 13, 2011
            • Tang T.H.C. and Tsang O.T.Y.
            • N Engl J Med 2011; 364:e3
            • Free Full Text

            A 43-year-old man presented with fever, malaise, a nonproductive cough, and skin lesions near the left eyelid and eyebrow (Panel A) and left antecubital fossa (Panel B). The symptoms had developed during the course of several weeks. The patient underwent ...

          • Images in Clinical Medicine

            Lobomycosis

            Figure 1.

            • January 6, 2011
            • Francesconi F. and Francesconi V.
            • N Engl J Med 2011; 364:e2
            • Free Full Text

            A 37-year-old man presented to our clinic with a 12-year history of skin lesions on his right ear. Several painless skin-colored nodules with a smooth surface and a fibrous consistency were located on the helix and antihelix of the right pinna, giving the ...

          • Images in Clinical Medicine

            Tinea

            Figure 1.

            • December 23, 2010
            • Lai-Cheong J. and McGrath J.
            • N Engl J Med 2010; 363:e39
            • Free Full Text

            A healthy 6-year-old boy presented to the emergency department with a blistering eruption on his right middle finger. He was otherwise in good health. The rash had started 10 days previously as an erythematous papule and rapidly progressed into an annular ...

          • Case Records of the Massachusetts General Hospital

            Case 35-2010 — A 56-Year-Old Man with Cough, Hypoxemia, and Rash

            Presentation of Case. A 56-year-old man was admitted to the hospital in the autumn because of cough, hypoxemia, and a rash. The patient had been well until 9 days earlier, when light-headedness, diffuse myalgias, chills, sweats, and extreme fatigue developed, which he thought were related to…

            • November 18, 2010
            • Kormos W.A., Wu C.C., Branda J.A., Piris A.
            • N Engl J Med 2010; 363:2046-2054

              A 56-year-old man was admitted to the hospital because of cough, hypoxemia, and rash. Nine days before admission, myalgias, chills, sweats, fatigue, and a dry cough developed, with a rash over the chest and flanks.

            • Case Records of the Massachusetts General Hospital

              Case 33-2010 — A 22-Year-Old Woman with Blurred Vision and Renal Failure

              Presentation of Case. Dr. Meghan E. Sise (Medicine): A 22-year-old woman was admitted to this hospital because of blurred vision and renal failure. The patient had been well until 1 week before admission, when she noted blurred vision in her right eye. The next day, she met with her primary care…

              • October 28, 2010
              • Young L.H., Bazari H., Durand M.L., Branda J.A.
              • N Engl J Med 2010; 363:1749-1758
              • CME

              A 22-year-old woman was admitted because of blurred vision and acute renal failure. One week earlier, pain and blurred vision had developed in the right eye. Valacyclovir, leucovorin, prednisone, sulfadiazine, and pyrimethamine were prescribed. Dark urine, nausea, and vomiting developed.

            • Images in Clinical Medicine

              Aspergilloma

              Figure 1.

              • March 18, 2010
              • Grech R.
              • N Engl J Med 2010; 362:1030
              • Free Full Text

              A 25-year-old Sudanese man with a 1-month history of coughing up bloodstained sputum was referred to our facility. Six years earlier, he had had a similar episode lasting 5 weeks, during which he had also had night sweats, weight loss, and fatigue. At ...

            • Correspondence

              Dectin-1 Deficiency and Mucocutaneous Fungal Infections

              To the Editor: Mucocutaneous candidiasis is commonly seen in persons with deficient T-cell–mediated immunity, including newborn infants, patients with the acquired immunodeficiency syndrome, and those with genetically defined primary T-cell deficiencies. In their Brief Report about human dectin-1…

              • January 28, 2010
              • N Engl J Med 2010; 362:367-368
              • Free Full Text

              To the Editor: Mucocutaneous candidiasis is commonly seen in persons with deficient T-cell–mediated immunity, including newborn infants, patients with the acquired immunodeficiency syndrome, and those with genetically defined primary T-cell deficiencies....

            • Original Article

              A Homozygous CARD9 Mutation in a Family with Susceptibility to Fungal Infections

              Chronic mucocutaneous candidiasis is characterized by impaired clearance of fungal infections and results in colonization and infections of the mucosa or skin, predominantly with Candida albicans. A variety of clinical conditions, such as infection with the human immunodeficiency virus or the use…

              • October 29, 2009
              • Glocker E.-O., Hennigs A., Nabavi M., et al.
              • N Engl J Med 2009; 361:1727-1735
              • Free Full Text

              Homozygous mutations in the CARD9 gene, with a premature termination codon, are associated with chronic mucocutaneous candidiasis in an Iranian family. Dysfunction of CARD9 impairs the innate signaling of dectin-1, an antifungal pattern-recognition receptor.

            • Original Article

              Brief Report: Human Dectin-1 Deficiency and Mucocutaneous Fungal Infections

              Recurrent vulvovaginal candidiasis is a relatively common pathological condition, afflicting women of all ages, with more than 90% of cases caused by C. albicans. Although the role of diabetes as a predisposing condition has been recognized, most cases occur in healthy women. Recurrent oral,…

              • October 29, 2009
              • Ferwerda B., Ferwerda G., Plantinga T.S., et al.
              • N Engl J Med 2009; 361:1760-1767
              • Free Full Text

              A family with recurrent mucocutaneous candidiasis was evaluated for a potential genetic cause. An early-stop-codon mutation in the β-glucan receptor dectin-1 was found in the affected family members. These data suggest an important role of dectin-1 in mucosal antifungal defense.

            • Editorial

              Yeast Infections — Human Genetics on the Rise

              We lead inextricably mycotic lives: yeasts leaven our bread, ferment our wine and beer, and inhabit our skins, mouths, and gastrointestinal tracts; however, not all is harmony. Hippocrates reported aphthous ulcers consistent with thrush in patients with severe debilitation, but it was not until the…

              • October 29, 2009
              • Holland S.M. and Vinh D.C.
              • N Engl J Med 2009; 361:1798-1801

                We lead inextricably mycotic lives: yeasts leaven our bread, ferment our wine and beer, and inhabit our skins, mouths, and gastrointestinal tracts; however, not all is harmony. Hippocrates reported aphthous ulcers consistent with thrush in patients with ...

              • Case Records of the Massachusetts General Hospital

                Case 29-2009 — An 81-Year-Old Man with Weight Loss, Odynophagia, and Failure to Thrive

                Presentation of Case. Dr. Jenica N. Upshaw (Medicine): An 81-year-old man was admitted to the hospital because of cough, weight loss, odynophagia, and failure to thrive. The patient had been in his usual state of health, with diabetes mellitus, until approximately 15 months earlier, when…

                • September 17, 2009
                • Stone V.E., Bounds B.C., Muse V.V., Ferry J.A.
                • N Engl J Med 2009; 361:1189-1198

                  An 81-year-old man was admitted to this hospital because of cough and weight loss for 15 months and recent onset of odynophagia and failure to thrive. He had a history of asbestos exposure. Chest imaging showed pleural plaques and bilateral pulmonary opacities. A barium swallow showed an abnormal esophageal mucosal pattern, with a cobblestone appearance, and an abdominal CT scan showed multiple low-attenuation lesions throughout the liver. Additional diagnostic tests were performed.

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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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