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Perspective
HIV–HBV Coinfection — A Global Challenge
Human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus (HBV) exact a high toll worldwide. Both can lead to chronic disease, cancer, and death, and neither can be eradicated with the use of current therapies. Antiviral drug resistance often develops after patients have received treatment…
- May 10, 2012
- Kourtis A.P., Bulterys M., Hu D.J., Jamieson D.J.
- N Engl J Med 2012; 366:1749-1752
- Free Full Text
Human immunodeficiency virus and hepatitis B virus exact a high toll worldwide. Both can lead to chronic disease, cancer, and death, and neither can be eradicated with the use of current therapies. Coinfection with the two viruses represents a major global health problem.
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Case Records of the Massachusetts General Hospital
Case 14-2012 — A 43-Year-Old Woman with Fever and a Generalized Rash
Presentation of Case. Dr. Sarah Gee (Dermatology): A 43-year-old woman was admitted to the hospital because of fever and a generalized rash. The patient had a history of atopic dermatitis and had been in her usual health until approximately 1 week before admission, when a painful, pruritic rash…
- May 10, 2012
- Mackool B.T., Goverman J., Nazarian R.M.
- N Engl J Med 2012; 366:1825-1834
- CME
A 43-year-old woman with a history of atopic dermatitis was admitted to the hospital because of fever and a generalized painful, pruritic rash involving the entire body. Examination revealed vesicles, pustules, and erosions with scalloped borders. A diagnostic test result was received.
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Perspective
Measles in the 21st Century
Barely 20 years ago, such a high proportion of childhood deaths globally was attributable to measles that the going estimate of more than 1 million measles-related deaths per year was almost certainly an underestimate. Pediatric wards in the developing world were filled with patients with measles…
- May 10, 2012
- Mulholland E.K., Griffiths U.K., Biellik R.
- N Engl J Med 2012; 366:1755-1757
- Interactive/Multimedia
Between 2000 and 2008, measles control improved markedly worldwide, but with poorer countries focused on polio eradication and some richer countries falling prey to opposition to vaccination, the measles genie seems to have slipped out of the bottle in recent years.
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Case Records of the Massachusetts General Hospital
Case 11-2012 — A 60-Year-Old Man with Weakness, Rash, and Renal Failure
Presentation of Case. Dr. Pritha Sen (Medicine): A 60-year-old man with a history of schizophrenia was admitted to this hospital in late spring because of weakness, rash, and renal failure. The patient was in his usual state of health until several days before admission, when fatigue and myalgias…
- April 12, 2012
- Channick R.N., Lorenzo M.E., Wu C.C., Hoang M.P.
- N Engl J Med 2012; 366:1434-1443
- CME
A 60-year-old man from coastal New England was admitted to this hospital because of fever, weakness, rash, and renal failure. An initial measurement of creatine kinase was 20,437 U per liter. A diagnostic test was performed.
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Review Article
Current Concepts: Dengue
Dengue is a self-limited, systemic viral infection transmitted between humans by mosquitoes. The rapidly expanding global footprint of dengue is a public health challenge with an economic burden that is currently unmet by licensed vaccines, specific therapeutic agents, or efficient vector-control…
- April 12, 2012
- Simmons C.P., Farrar J.J., van Vinh Chau N., Wills B.
- N Engl J Med 2012; 366:1423-1432
- CME
There are an estimated 50 million infections per year with the dengue virus, which is transmitted primarily by urban-adapted Aedes aegypti mosquitoes. This review summarizes pathophysiology and treatment as well as prospects for a vaccine and for vector-control approaches.
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Clinical Practice
Lichen Planus
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 53-year-old…
- February 23, 2012
- Le Cleach L. and Chosidow O.
- N Engl J Med 2012; 366:723-732
- CME
- Full Text Audio
Lichen planus, an inflammatory disease, tends to affect the skin and oral mucosa but may involve the nails, scalp, esophagus, and anogenital regions. Its various clinical presentations and treatment options are reviewed, including available data to guide management.
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Images in Clinical Medicine
Spider Angioma
Figure 1.
- February 23, 2012
- Caseiro M.M. and Pinto da Costa S.O.
- N Engl J Med 2012; 366:e13
- Free Full Text
- Video
A 62-year-old man was referred to the hepatology clinic for evaluation of elevated levels of aspartate and alanine aminotransferase, detected on routine laboratory examination. The patient reported no symptoms except for a reddish lesion on his forehead.
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Case Records of the Massachusetts General Hospital
Case 3-2012 — A Newborn Boy with Vomiting, Diarrhea, and Abdominal Distention
Presentation of Case. Dr. Rebecca C. Bell (Pediatrics): A 6-day-old boy was admitted to this hospital because of vomiting, diarrhea, and abdominal distention. The patient was born at another hospital to a teenaged primigravida by vaginal delivery after a full-term, uncomplicated gestation. The…
- January 26, 2012
- Melendez E., Goldstein A.M., Sagar P., Badizadegan K.
- N Engl J Med 2012; 366:361-372
A 6-day-old boy was admitted to the hospital because of vomiting, diarrhea, and abdominal distention, which had begun earlier that day and worsened. On admission, he showed signs of sepsis. Imaging showed narrowing of the rectosigmoid colon.
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Original Article
Preliminary Study of Two Antiviral Agents for Hepatitis C Genotype 1
Approximately 180 million people worldwide are infected with hepatitis C virus (HCV), including 4.1 million in the United States. HCV infection is the most common cause of chronic liver disease in the United States and a leading cause of cirrhosis and hepatocellular carcinoma globally. HCV is…
- January 19, 2012
- Lok A.S., Gardiner D.F., Lawitz E., et al.
- N Engl J Med 2012; 366:216-224
- CME
In 21 patients with hepatitis C virus genotype 1 infection who had had no response to prior treatment, sustained virologic responses were achieved in 4 of 11 who were treated with two antiviral agents alone and in 9 of 10 who were treated with the antiviral agents plus peginterferon and ribavirin.
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Editorial
A Watershed Moment in the Treatment of Hepatitis C
More than 170 million persons harbor chronic infection with hepatitis C virus (HCV), the leading indication for liver transplantation worldwide. For more than 20 years, treatment of chronic hepatitis C infection has relied on the use of the nonspecific antiviral cytokine interferon alfa, which…
- January 19, 2012
- Chung R.T.
- N Engl J Med 2012; 366:273-275
More than 170 million persons harbor chronic infection with hepatitis C virus (HCV), the leading indication for liver transplantation worldwide. For more than 20 years, treatment of chronic hepatitis C infection has relied on the use of the nonspecific ...
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Original Article
Efficacy Results of a Trial of a Herpes Simplex Vaccine
Both herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) can cause primary infection of the genital tract, and HSV-1 infection has become an increasingly frequent cause of genital disease. The majority of HSV infections are asymptomatic, and only 10 to 25% of persons with HSV-2 antibodies have…
- January 5, 2012
- Belshe R.B., Leone P.A., Bernstein D.I., et al.
- N Engl J Med 2012; 366:34-43
- CME
There is no vaccine to prevent herpes simplex virus (HSV) infection. In this trial in 8323 women, a candidate HSV vaccine containing glycoprotein D was found to be ineffective in preventing HSV-2 infection.
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Original Article
Norovirus Vaccine against Experimental Human Norwalk Virus Illness
Noroviruses are a leading cause of epidemic acute gastroenteritis and are also an important cause of sporadic cases of acute gastroenteritis. Because human noroviruses have not been grown in cell culture and there are no convenient animal models in which to evaluate immunity and illness, much of…
- December 8, 2011
- Atmar R.L., Bernstein D.I., Harro C.D., et al.
- N Engl J Med 2011; 365:2178-2187
There are neither specific therapies for nor a vaccine to prevent norovirus infection, a common cause of gastroenteritis. This study showed that a candidate norovirus vaccine confers modest protection against an experimental homologous norovirus challenge.
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Perspective
Making Sense of the New Cervical-Cancer Screening Guidelines
Over the past 60 years, U.S. mortality from cervical cancer has dropped by 70%, thanks to a successful screening program. In 1995, the American College of Obstetricians and Gynecologists (ACOG)recommended screening with the Papanicolaou (Pap) smear and pelvic examination at the initiation of sexual…
- December 8, 2011
- Feldman S.
- N Engl J Med 2011; 365:2145-2147
In the past 2 years, four major U.S. health care organizations have issued new guidelines on cervical-cancer screening. Although there are differences among them, all agree on some points, including that screening shouldn't begin before age 21 in immunocompetent women.
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Correspondence
Intussusception after Rotavirus Vaccination — Spontaneous Reports
To the Editor: Patel et al. report an increased risk of intussusception after rotavirus vaccination. We conducted a case-series analysis of 151 spontaneous reports of intussusception worldwide after administration of the rotavirus vaccine RV1 (Rotarix, GlaxoSmithKline Biologicals). On the basis of…
- December 1, 2011
- N Engl J Med 2011; 365:2139
- Free Full Text
To the Editor: Patel et al. report an increased risk of intussusception after rotavirus vaccination.¹ We conducted a case-series analysis² of 151 spontaneous reports of intussusception worldwide after administration of the rotavirus vaccine RV1 (Rotarix, ...
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Original Article
Regulatory T-Cell Responses to Low-Dose Interleukin-2 in HCV-Induced Vasculitis
Interleukin-2 has been identified for its capacity to stimulate T cells in vitro and has been used to boost effector immune responses in patients with cancers and infectious diseases. It is a registered indication when used as an adjunct for the treatment of renal-cell carcinoma, but there is a…
- December 1, 2011
- Saadoun D., Rosenzwajg M., Joly F., et al.
- N Engl J Med 2011; 365:2067-2077
This phase 1–phase 2a study of the use of low-dose interleukin-2 to treat vasculitis associated with HCV infection suggests the presence of a therapeutic effect that is mediated by an increase in regulatory T cells.
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Editorial
The Yin and Yang of Interleukin-2–Mediated Immunotherapy
In this issue of the Journal, the findings of two case series suggest that in vivo treatment with interleukin-2 can suppress immune-mediated diseases. In one study, Koreth et al. found that low-dose interleukin-2 was associated with reversal of glucocorticoid-refractory chronic graft-versus-host…
- December 1, 2011
- Bluestone J.A.
- N Engl J Med 2011; 365:2129-2131
In this issue of the Journal, the findings of two case series suggest that in vivo treatment with interleukin-2 can suppress immune-mediated diseases. In one study, Koreth et al.¹ found that low-dose interleukin-2 was associated with reversal of ...
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Images in Clinical Medicine
Zoster of the Tympanic Membrane
Figure 1.
- November 17, 2011
- Watanabe K. and Funaki M.
- N Engl J Med 2011; 365:e40
- Free Full Text
A 44-year-old man presented with severe right otalgia after an outbreak of a rash on the right side of his face. He had been treated for AML with cord-blood stem-cell transplantation 6 months earlier and had received immunosuppressive therapy with glucocorticoids.
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Images in Clinical Medicine
Lingual Zoster
Figure 1.
- November 3, 2011
- Lee C.-K. and Baek B.J.
- N Engl J Med 2011; 365:1726
- Free Full Text
A 72-year-old woman presented to the ER with white patches on the right side of her tongue and slight palsy on the right side of her face, reporting that the symptoms had developed 4 days earlier. She also reported dizziness, otalgia, nausea, and vomiting.
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Images in Clinical Medicine
Human Papillomavirus Lesions of the Oral Cavity
Figure 1.
- October 27, 2011
- Stoopler E.T. and Balasubramaniam R.
- N Engl J Med 2011; 365:e37
- Free Full Text
A 49-year-old man who was HIV-positive and had type 2 diabetes presented with multiple papillary lesions in his mouth and throat. The lesions, which had developed 10 years earlier and had increased in size and number, had been evaluated but not diagnosed or treated.
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Original Article
HPV Vaccine against Anal HPV Infection and Anal Intraepithelial Neoplasia
Anal cancer is biologically similar to cervical cancer, including having a causal relationship with human papillomavirus (HPV) infection. Although HPV type 6 (HPV-6) or HPV type 11 (HPV-11) alone is rarely causal, the proportion of anal cancers associated with infection with HPV type 16 (HPV-16) or…
- October 27, 2011
- Palefsky J.M., Giuliano A.R., Goldstone S., et al.
- N Engl J Med 2011; 365:1576-1585
- Free Full Text
- CME
Infection with human papillomavirus (HPV) serotypes 16 and 18 in men who have sex with men is a cause of considerable morbidity associated with anal intraepithelial neoplasia. This study shows that the HPV vaccine decreases the risk of HPV-associated anal disease.
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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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