Psoriasis is an autoimmune condition in which the immune system attacks healthy skin cells, causing the accelerated formation of new skin characterized by scaly patches or plaques. These lesions are formed due to the formation of new skin underneath dead skin that has yet to be shed. Although the cause of psoriasis is not completely understood, it has been associated with infections that may trigger or exacerbate the condition. Syphilis, a highly infectious sexually transmitted disease, may trigger a psoriasis outbreak; because syphilis is known as "the great imitator", it can present as many other chronic dermatoses and therefore often makes it very difficult to diagnose. Here, we describe a case of a 17-year-old Vietnamese male from Dong Nai Province who was initially diagnosed with psoriasis and later diagnosed with syphilis and HIV infection upon further investigation and testing.
Congenital patellar dislocation (CPD) is a rare deformity in children that involves a laterally displaced patella. While potentially identified in early childhood using diagnostic imaging techniques, it is often misdiagnosed at birth, creating pain and mobility issues as the child grows. Dislocation of the patella is permanent and manually irreducible, often manifesting with flexion contracture of the knee, genu valgum, external tibial torsion, and foot deformity. Surgical correction is the treatment of choice in order to prevent future sequelae. We herein present a case of CPD in a four-year-old Asian male who was initially misdiagnosed before undergoing successful surgical repair using the Roux-Goldthwait technique.
Psychogenic Polydipsia (PP) is a condition involving excessive fluid intake causing hyponatremia. While the mechanism is unknown, treating arginine vasopressin (AVP) dysregulation with the class of drugs, vaptans, during acute psychotic episodes has been an effective treatment. These patients may present with a triad of acute psychosis, polydipsia, and electrolyte imbalances suggesting a syndrome of inappropriate antidiuretic hormone. Our patient is a 57-year-old female with a past medical history of schizophrenia who presented with seizures due to severe hyponatremia in the context of excessive water consumption and mild delusions regarding her sister. Her episodes of neural dysfunction started after she stopped taking her antipsychotic medications, making a drug-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH) less likely. However, she had a normal urine osmolality raising suspicion of antidiuretic hormone involvement. The mechanism of hyponatremia in the context of polydipsic schizophrenia is not well established. Some evidence suggests that brain changes may cause AVP dysregulation, which can be exacerbated by acute psychotic episodes. Our case report describes a clinical scenario with the clinical triad of acute psychosis, polydipsia, and electrolyte imbalances suggestive of this mechanism.
This article has been corrected due to the erroneous omission of second author, Skyler Coetzee, by the submitting author. Skyler Coetzee is now correctly listed as the second author. The authors sincerely regret the error. 1 2 3
The rise of the opioid epidemic over the last two decades has increased the mortality rate, healthcare cost, and drug overdose deaths across the country. Practicing physicians are lacking in education regarding non-opioid alternatives to pain management, prevention, diagnosis, and treatment of opioid use disorder (OUD). Existing literature suggest a link between knowledge discrepancy and opioid use among clinicians resulting in patient’s abuse of opioids. Therefore, it is important to educate medical students at the start of their career. This preliminary study assesses the current knowledge and perceived skills of medical students regarding (OUD)/opioid misuse and related content in order to identify gaps and provide necessary education. The study used a pre-post survey method to understand the demographics, medical, and clinical knowledge about opioid use, abuse, and clinical knowledge regarding patient opioid overdose. The self-administered survey was administered to all students 18 years or older, M1- M4 enrolled in NSU-KPCOM. A total of 1164 students met these criteria. However, only 137 students participated in the Pre-survey collected from August 2019 to September 2019. Approximately 12% of the eligible students participated in the pre-survey. Data was analyzed using frequencies and percentages. Results of the pre-survey suggest a progressive increase in opioid knowledge from M1 to M4 years. Results of the study suggest investigating a relationship between medical education and knowledge of opioid usage, with a specific lens aimed at assessing the efficacy of opioid education during second and third years of medical school
Reticulate acropigmentation of Kitamura (RAPK) is a rare genetic hyperpigmentation disorder that is a member of the dyschromatoses characterized by hyperpigmented macules or papules that may interrupt the dermatoglyphics with extra-dermatological manifestations. We present a case of a 29-year-old black male who presented with hyperpigmented atrophic macules both on the extremities and genitals, as well as bilateral clinodactyly of the 5th fingers and inferior gingival hyperplasia with teeth crowding, to draw attention to the novel extra dermatological manifestations of RAPK and the differential diagnosis of cutaneous hyperpigmented lesions.
Thromboangiitis obliterans (TAO) is an autoimmune vasculitis that typically presents in male smokers between the ages of 25 and 40. Although TAO primarily affects medium-sized blood vessels, it can also infiltrate small blood vessels as well as nerves and veins. The inflammation can cause segmental thrombosing and occlusion of the blood vessels leading to gangrene and eventual amputations. This case presents a unique sequela of TAO, in which a 28-year-old male with a chronic tobacco smoking history was diagnosed with TAO after presenting with pain and discoloration in his foot, in addition to superimposed osteomyelitis. This case serves to remind emergency clinicians, internal medicine physicians, general practitioners, and infectious disease specialists of the TAO differential in patients presenting with pain and discoloration in the feet, as well as the importance of working up the patient for any superimposed infections.
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