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A 40-year-old man presented with asymptomatic reddish scaly lesions of 2 weeks’ duration. The patient had had painful swollen ankles and knees for 5 years. Erythematous annular scaly psoriasiform plaques with peripheral pustules coalescing at places to form circinate lesions, along with postinflammatory hyperpigmentation, were observed all over the body (a, b). The patient had classical lesions of keratoderma blenorrhagicum (c). His nails were dystrophic. Genital examination revealed circinate balanitis (d). Ocular examinations were normal. Urethral smear was positive for chlamydia on polymerase chain reaction. Human leucocyte antigen-B27 was positive. The histopathological features were conforming to that of circinate balanitis (e). Differential diagnoses and comments are welcome.

Reactive arthritis.

Male (21) consults for presence of right inguinal mass, 4 weeks of evolution. Refers regional pain (4/10), night sweats and weight loss (4kg) in this last 2 weeks, also he mentions that the mass presents suppuration of serous fluid in this last 2 days. He denies dyspareunia, urinary symptoms, or urethral discharge. Important background: He refers 10 sexual partners in the last 2 years (sometimes use condom), denies drug use and refers that 6 weeks ago he was bitten by a cat on the finger he did not receive medical attention and presented a nodule that disappeared. Due to inguinal mass he received a 10-day ciprofloxacin regimen without improvement. A complete physical examination is performed, the only relevant findings are: Pharyngeal hyperemia with a slight increase in tonsils. The right inguinal nodule is palpable, mobile, painful and warm. Presents serous fluid at pressure. Rest of the genital examination without alterations. VIH 1/2 quick test: No reactive, VDRL negative Blood biometry:Without any altered parameter USG:Reports 3 hypoechogenic images of sizes 3 x 4, 10 x 10, 7x5 mm compatible with inflammatory inguinal nodes. The patient does not have the resources to perform more tests (cultures or serology), so the diagnosis was based on the physical examination and the USG report. The main diagnosis was Lymphogranuloma venereum for which a single dose of azithromycin and 3 weeks with doxycycline were indicated. Any other diagnoses that you can think of ? I am intrigued by the antecedent of cat bite, you would think of cat scratch fever as a cause of inguinal lymphadenopathy ? Thank you for your opinions and comments.

#laparoscopic #cholecystectomy. Can any of my fellow medical students name the syndrome that could have led to the hepatic adhesions?

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A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?