Figure 1. A 56-year-old woman with a medical history notable for epilepsy, scoliosis, and chronic constipation presented with shortness of breath and cough, which she reported having had for the past 10 days. A chest radiograph was obtained. Her medications consisted of phenytoin, tegaserod,…

To the Editor: The medical mystery in the April 5 issue 1 involved a 34-year-old bank employee who presented with black discolorations of the skin ( Figure 1A) on all her fingers. The discolorations had developed in the evening after work. A skin-biopsy specimen of the black spots revealed brownish deposits…

To the Editor: The Medical Mystery in the October 6 issue 1 shows a 10-year-old boy with one brown and one blue eye, with mild ptosis and miosis of the lighter, left eye ( Fig. 1). Both eyes respond equally to light and have normal vision; both are normal on funduscopic examination. The eyes of the boy's…

…[glycoprotein 330]) were unrewarding. 6 Thus, the true pathogenesis of human idiopathic membranous nephropathy remained unresolved. Now, this long-lasting mystery may well have been solved by Beck et al., 7 as reported in this issue of the Journal. Autoantibodies against an antigen normally expressed on the podocyte…

Figure 1. A 16-year-old boy presented with a two-year history of hyperpigmentation of the skin; his sclera were unaffected. He is shown with his mother for comparison. What is the diagnosis?

Figure 1. A male infant was born at 38 weeks and 1 day of gestation with a weight of 3430 g. When the child was five months old, his mother noticed an unusual weight gain and a rash. He was referred for medical treatment at seven months of age. His weight was 8450 g, and his blood pressure was…

Figure 1. Which of these 50-year-old identical twins is the patient? And what is the diagnosis?

Figure 1. A 73-year-old man with a previous history of hypertension and diabetes mellitus had undergone aortic-valve replacement for aortic stenosis and received a pacemaker for a junctional rhythm several years earlier. A routine follow-up chest x-ray film raised the possibility of an aortic-arch…

Figure 1. A 62-year-old man presented with a one-month history of digital gangrene affecting the right hand (Panel A). One digit had been partially amputated 20 years before, after an accident. The skin of his arms and legs had reddish-blue, mottled discolorations in a net-like pattern (Panel B)…

Figure 1. Figure 1. A 79-year-old woman presented to the emergency department with a several-hour history of facial swelling (Panel A). The photograph shown in Panel B was taken seven days later. What is the diagnosis?

Figure 1. A 55-year-old man, whose plain abdominal film is shown here, had a history of recurrent flank pain. What is the diagnosis?

Figure 1. Figure 1. This 82-year-old woman was referred to a physician. What is the diagnosis?

Figure 1. A 71-year-old-man presented to the emergency department with dizziness, progressive lethargy, and confusion, which he reported having had for the past 10 days. A complete blood count showed pancytopenia. A peripheral-blood smear (Panel A) and bone marrow aspirate (Panel B) are shown. What…

Figure 1. A 50-year-old woman presented to the emergency department with obtundation and hypotension. She had a 1-month history of slight fever, before which she had been well. On abdominal examination, an immobile, tender, firm mass was palpated to the right of the umbilicus. Laboratory evaluation…

Figure 1. A 62-year-old man presented with an ileus, marked abdominal distention, hypotension, and oliguria. He had a 15-year history of chronic psychosis. Laboratory findings included renal dysfunction, abnormal liver-function values, and marked hyponatremia. A total of 4800 ml of fluid was…

Figure 1. A 23-year-old Peace Corps volunteer lived in a traditional mud hut with a thatched roof in a rural savannah village in Gambia. Several painless ulcers developed on his lower legs during a three-month period. The lesions did not respond to local antimicrobial therapy (2 percent fucidic…

Figure 1. A 70-year-old man presented with a history of increasing abdominal distention. On physical examination, the patient was afebrile and his abdomen was soft and nontender. An abdominal radiograph raised concern about a sigmoid volvulus; thus, a computed tomographic (CT) scan of the abdomen…

The medical mystery in the June 21 issue 1 involved a 28-year-old woman with a 1-year history of high blood pressure that was diagnosed during her first pregnancy. In addition to an elevated blood pressure, at 200/100 mm Hg, in the left arm, physical examination revealed a grade 3/6 midsystolic murmur…

Figure 1. An 82-year-old woman presented with respiratory symptoms, and a chest film was obtained. Six years later, she presented with epigastric pain, nausea, and vomiting. What is the diagnosis?

Figure 1. A 69-year-old man presented to the emergency department with a 3-day history of left-sided lower abdominal and groin pain. The pain had begun 36 hours after the patient had undergone colonoscopy, at which time he was found to have extensive diverticular disease. He had undergone…