(BMJ) - History: 27-yo woman with fatigue, SOB on exertion, and difficulty swallowing food. Exam: angular cheilitis, pallor, koilonychia. Lab: hypochromic, microcytic anemia, Hb 5.6 g/dL, increased TIBC. An EGD and barium swallow were done. Diagnosis?
Bulimia
Vitamin C deficiency
Hemochromatosis
Plummer-Vinson syndrome
Esophageal cancer
You are correct. This patient has the classic triad of Plummer-Vinson syndrome (aka sideropenic dysphagia): dysphagia, iron-deficiency anemia, and upper esophageal webs. Iron therapy relieves the dysphagia, though some patients may require endoscopic web dilation. It is associated with an increased risk of UGI tract malignancy.
Left Foot
Right Hand
Left Hand
Right Foot
You are correct. Darth Vader chopped off his son's right hand.
(BMJ) - A 72-yo man with AML developed lesions on his foot, leg, and face 1 wk after starting combination chemotherapy, 2 days after broad-spectrum antibiotics for fever and CXR infiltrate. At day 14 he was pancytopenic and persistently febrile on antibiotics.
Necrotizing fasciitis
Stevens-Johnson syndrome
Sweet syndrome
Disseminated Fusarium infection
Herpes simplex
You are correct. Multiple randomly distributed centrally necrotic skin lesions with lung consolidation is classic for disseminated Fusarium infection. Skin bx showed intravascular ovoid structures on fungal stains, consistent with Fusarium. Skin lesions continued to develop despite amphotericin B and voriconazole; switching to oral posaconazole led to slow resolution of skin lesions and pulmonary infiltrates. He died of refractory AML 4 months later.