SAEM Clinical Image Series: Rash and Headache in Acute Myeloid Leukemia

Rash and Headache in AML 1, disseminated herpes zoster

A 25 year old male with a history of acute myeloid leukemia (AML) after an allogeneic stem cell transplant, which has been in remission for 6 years. He presents with a headache and rash. 4 days ago the patient noticed a rash on the abdomen that was itchy, but not painful. Today, he noticed a similar rash on his face.

The headache started yesterday, waking him up from sleep. It is now slowly getting worse. He endorses chills, nausea, neck stiffness, neck pain, myalgias, and photophobia. He denies fevers, vomiting and phonophobia. He does have small headaches regularly but this headache is one of the most painful of his life. He does not take any immunosuppressants or medications.

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2019-12-04T09:24:29-08:00

SAEM Clinical Image Series: Bellybutton Mass

BellyButton Mass umbilical granuloma

A 4 week-old female infant presents due to yellow discharge from her umbilicus and mom noticing a red mass coming from the umbilical area after changing her diaper today. She is a healthy infant born at 40 weeks by vaginal delivery without complications and weighed 6 lbs 1 oz at birth. She is feeding 4 oz of formula every 3-4 hours. She received immunizations at birth and has an established pediatrician.

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2019-11-24T15:52:41-08:00

SAEM Clinical Image Series: Facial Burn

levamisole

A 50-year-old female with a history of bipolar disorder, ADHD, anxiety, depression, and alcoholism presented to the ED after her family found her at home agitated, restless, and with a “large black burn” on her face. Her husband reported that she had been “picking” at this area of her face earlier in the day; at that time it appeared only slightly red. Per her husband, the patient had also felt “bugs crawling on her legs” and had been picking at and grabbing her legs on the day of presentation.

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2019-11-07T20:52:47-08:00

SAEM Clinical Image Series: Chest Wall Mass

Under skin lung herniation

A 71 year-old patient with a past medical history of hypertension, percutaneous transluminal coronary angioplasty 7 years ago, and robotic coronary artery bypass grafting of the left internal mammary artery to the left anterior descending artery 9 years ago presents with worsening dyspnea on exertion. He had a biopsy of the upper lobe of the left lung the week before. He was having a neoplastic mass evaluated. The patient presents with a soft left-sided anterior chest mass, inflating and deflating with respiration.

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2019-11-06T17:57:56-08:00

SAEM Clinical Image Series: Mysterious Blood Sample

Mysterious Lab hypertriglyceridemia

34-year-old female with a history of hypertension, diabetes mellitus, and pancreatitis presents for epigastric and left upper quadrant abdominal pain. Her symptoms started yesterday evening and have been worsening since onset. She reports chronic epigastric pain that waxes and wanes for several years since her first episode of pancreatitis in 2014. Yesterday she had an abrupt onset of nausea that accompanied the pain without emesis. The pain worsened and is now currently 10/10 in severity. She describes it as severe and deep. She has no bloody or dark stool. She denies any heavy alcohol use, changes in medications, or drug use.

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2019-11-06T18:36:53-08:00

SAEM Clinical Image Series: Eye Trauma and Vision Loss

globe rupture open globe

The patient is a 44-year-old male with a past history of end stage renal disease on hemodialysis, diabetes, and hypertension who presents with acute visual loss after assault 2 hours prior. He was struck in the eye by his partner’s fist (adorned with a large ring), but denies severe pain. He does endorses instant difficulty with his vision. There is no use of contacts or glasses. No other injuries, headache, or loss of consciousness are reported.

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2019-11-10T21:42:57-08:00

SAEM Clinical Image Series: Double Vision

cranial nerve palsy CN3

Chief complaint: Double vision

History of Present Illness: 61 year old female with history of HTN, DM, hyperlipidemia, and chronic low back pain presenting with double vision. She received an epidural spinal injection yesterday for the 4th time for low back pain. She was sedated for the procedure and woke up with headache, neck stiffness, and left eye “jumping around,” which progressed to double vision 1 hour later.

There was no blurry or double vision with either eye closed. She had 1 episode of emesis. She presented to the ED 24 hours later with continued headache and double vision.

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2019-10-30T21:13:07-07:00