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While cerebrospinal fluid is ordinarily clear, this patient’s was green. Why?

This cerebrospinal fluid (CSF) is green due to a ventriculoperitoneal shunt infection with Pseudomonas aeruginosa. The bacteria produces pigments that combine to produce its distinctive color. Management often includes antibiotic therapy and removal of the shunt. A new shunt can be placed once the CSF is sterile. To see the full discussion, view this case on Figure 1. Find the link in our bio page.

It is estimated that lightning strikes account for up to 24,000 deaths and 240,000 injuries globally each year. Lightning injuries typically involve multiple systems. This patient presented with a distinct burn after being indirectly struck by lightning.

This ferning pattern, known as a Lichtenberg figure, occurs due to the electrical current travelling along the skin's surface before being discharged to the ground. These markings can help indicate to medical examiners the cause of a patient’s death. In survivors, they generally fade within hours or days.

See this case on Figure 1 by following the link in our bio.

A 62-year-old female presents with fatigue and innumerable pruritic, keratotic lesions on her back and neck which she says developed quite suddenly two months ago. A blood test reveals a microcytic anemia with hemoglobin of 9.1 g/dL.

What is the most likely underlying condition? To see the answer and full discussion, view this case on Figure 1. Find the link in our bio page.

These lip lesions have been present in this newborn since birth. They are essentially asymptomatic and cause some mild difficulty with breastfeeding. They appear a bit too firm, yellow and fleshy to be a typical mucocele.

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A 26-year-old male presented with a 1.5-month left-sided visual loss and 1-month intermittent frontal and suboccipital headaches. Ophthalmology evaluation revealed intracranial HTN, bilateral papilledema, and left superior homonymous hemianopsia. He denied nausea/vomiting, sensorimotor symptoms, autonomic dysfunction, or neuroendocrine symptoms.

What’s the diagnosis? See the answer and full case description from @mountsinaipathology by following the link in our bio.

A 45-year-old female presents to the emergency department with abdominal pain and vomiting. She mentions the pain radiates to her right shoulder and has been constant for about six hours. She is febrile and the right upper quadrant of her abdomen is tender. Laboratory tests reveal leukocytosis and an abdominal ultrasound demonstrates a thickening of the gallbladder wall and the presence of gallstones. She undergoes a laparoscopic cholecystectomy and several black pigment stones are removed. ⠀

When a medical student asks why these stones are black, they are told to consult the patient’s medical history and medications. What medication hints at the reasoning for the color of these stones? View the quiz and full case discussion on Figure 1. ⠀

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Our weekly pediatrics digest brings succinct roundups of recent research and our popular quizzes right to your inbox.

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A 44-year-old female recently diagnosed with acute myeloid leukemia presents with a five-day history of a ​fever, malaise, and a painful rash ​approximately three weeks after chemotherapy​. ⠀

Examination reveals erythematous papules on her back, arms, and the ​dorsum of both hands. A blood test shows an elevated white cell count and a skin biopsy is performed. What is the most likely diagnosis?⠀

To see the answer and full discussion, view this case on Figure 1. Find the link in our bio page.

A 16-year-old male presents with a two-history of abdominal pain and 3-4 days of fatigue. He has not had any fevers. Creatinine is 1.36 mg/dL and a chest X-ray demonstrates the findings seen here.

What’s the diagnosis? What would you do next? Tap the link in our bio to see the @humandx case.

This World AIDS Day, we're highlighting the ongoing efforts of MSF/Doctors Without Borders. In this case, they detail the work of the Nsanje HIV TB District Support program in Malawi.
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How do you translate a 2D CT scan into 3D human anatomy?

This case from our top neurosurgeon offers some pointers.

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After diving to a depth of 50ft while spear fishing, a 24-year-old M begins coughing up bright red blood. Follow the case as Brown University's EM residency walks through their treatment plan.

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