SAEM Clinical Images Series: Face and Chest Rash
A 23-year-old female with a past medical history of asthma presented with a rash that began five days ago on her face and spread to her chest. The lesions are painful and pruritic, spreading slightly to her extremities. She noted a slight sore throat and nasal congestion. She denied any known fever and had no known vaginal or oral lesions. She has a 5-year-old daughter at home with no known symptoms. She is sexually active with one male partner who has no rash or illness. She is vaccinated for COVID-19. She is unsure of childhood [+]
ACMT Toxicology Visual Pearl: Needle to Necrosis
Which of the following agents, when injected along with heroin, is associated with the skin changes pictured? Cocaine Fentanyl Methamphetamine Xylazine Photo by Dr. Matthew Salzman [+]
Christiana Agbonghae, MD
Carolinas Medical Center
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SAEM Clinical Images Series: Utility of Bedside Ultrasonography
A 24-year-old G1P0010 female with a PMHx of ovarian cyst (unknown laterality) and emergency contraceptive use 3 months prior presented with sudden onset abdominal pain (upper > lower) that awoke her from sleep four hours prior to presentation with associated nausea and mild lower back pain. The pain is 10/10, sharp, stabbing, and diffuse. Additionally, she reported trace white vaginal discharge at baseline. No acute increase. She had intermittent vaginal bleeding since contraception use over the past two months, which has now resolved. She denied fever, chills, vomiting, chest pain, shortness of breath, diarrhea, or [+]
ACMT Toxicology Visual Pearl: Poison Dart Frog
The toxin from the golden poison dart frog most resembles which of the following in its mechanism of action? Botulinum toxin Bufotoxin Grayanotoxin Palytoxin Tetrodotoxin Photo adapted from Wilfried Berns (Wikimedia Commons) [+]
Nathaneal Franks, MD
Carolinas Medical Center
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SAEM Clinical Images Series: Pediatric Genitourinary Bleeding
A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear. There is no history of any recent falls or trauma, abdominal pain, pain to the vagina, dysuria, prior incidents of vaginal bleeding, or any noticeable behavioral changes per the grandmother. The patient lives at home [+]
ACMT Toxicology Visual Pearl – Apricot Kernels: Eat or pass?
What toxin is found in bitter apricot kernels? Cardiac glycoside Cyanogenic glycoside Dinitrophenol Lysergic Acid [+]
Maureen Nsofor, MD
Atrium Health’s Carolinas Medical Center
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SAEM Clinical Images Series: More Than Skin Deep
A 57-year-old female college counselor living in the northeastern United States with no PMH presented for evaluation of rash, joint pain, and dyspnea for the past three weeks. The patient first noticed the rash on her upper back, describing it as being itchy. The rash then spread to her face, scalp, and thighs. Two weeks ago, she noticed swelling in her hands and had a gradual onset of dyspnea on exertion. The patient has pain in her hands and when moving her fingers. She denied fever, cough, chills, chest pain, headache, vision changes, focal weakness, [+]
SAEM Clinical Images Series: Man with a Recurrent Rash
A 33-year-old male presented to the emergency department with a diffuse pruritic rash that appeared several days after starting Trimethoprim/Sulfamethoxazole (TMP-SMX) for a dental infection. Initially beginning on the torso and low back, the rash spread to the palms, soles, and genitalia. Progression stopped after discontinuing TMP-SMX. He conveyed a remote history of a similar rash following use of an unknown medication, and noted that several of the current lesions arose at the same location as previous. Skin: Widely distributed violaceous, non-blanching patches with a dusky center. Lesions ranged from 3 [+]
ACMT Toxicology Visual Pearl: Making Rash Decisions
Which of the following best describes the pictured rash occurring 4 weeks after starting minocycline? Anaphylaxis Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Erythema multiforme Serum sickness Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) [+]
Destiny D. Folk, MD
Carolinas Medical Center
Latest [+]
SAEM Clinical Images Series: Wolf in Sheep’s Clothing
A 55-year-old female with a history of hyperlipidemia presents after a syncopal episode. She had mild nausea and diarrhea on the morning of presentation but otherwise had no prodromal symptoms before suddenly losing consciousness in a grocery store. Of note, she recalls a similar syncopal episode in the remote past, also preceded by gastrointestinal symptoms at that time. At present, she is symptom-free. Vitals: BP 135/71; HR 52; Temp 98°F; RR 18; SpO2 100% on room air General: Tired appearing CV: 2+ peripheral pulses. Regular rate and rhythm, no murmurs, rubs, or [+]