Clinical

Do you recognize these ring-shaped lesions?

Figure 1 Quiz of the Week A 69-year-old woman with a history of hypertension and irritable bowel syndrome presents with multiple ring-shaped lesions on both hands. The lesions are non-pruritic and developed over the past four days. When she visits for follow-up two weeks later, the lesions remain present.    Original image posted by @osler1982....

Why did these lesions appear?

Figure 1 Quiz of the Week A 58-year-old woman presents two days after a cardiac catheterization with malaise, fatigue, and new violaceous livedoid lesions on her feet. She is also found to have mild acute renal dysfunction.   Image credit: @hfehmi.   Answer: Cholesterol embolization syndrome When small particles of atheroma embolize during a vascular...

A prescription for pain

Figure 1 Quiz of the Week A 70-year-old male with a history of hypertension presents with a fever and severe pain in both his hands. Examination reveals swollen, erythematous, and tender nodules on the joints of his fingers. Arthrocentesis demonstrates negatively birefringent urate crystals in the synovial fluid.    Image credit: @drugpiter, @twcc.   Answer: Precocious...

What’s causing this patient’s spontaneous laughter?

Figure 1 Quiz of the Week A 45-year-old female presents with painful lesions on her lower limbs and ears. She is a smoker, and has a history of recreational drug use. Purpuric, necrotic lesions are noted on both lower extremities, in addition to tender purpura on both ears. A biopsy is performed which demonstrates leukocytoclastic...