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Right arm extensor surface (A) and left arm volar surface (C) prior to steroid therapy, depicting mottled erythema together with subcutaneous calcific deposits at the volar aspect of the upper arm, forearm, and antecubital fossa. Right arm (B) and left arm (D) after initiation of high-dose steroid therapy, showing marked improvement and resolution in erythema.

Febrile Calcinosis in Scleroderma

The collagen vascular diseases can be challenging for the internist and are associated with higher utilization of resources and less favorable outcomes among patients admitted to the inpatient medicine services.1 In this context, the acquisition of proficiency in recognizing a range of disease manifestations, common and uncommon, and familiarity with the appropriate therapeutic interventions are critical […]

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(A) Three-dimensional reconstruction of the computed tomography scan demonstrating aneurysmal dilation of the entire length of descending thoracic and abdominal aorta. (B) Computed tomography angiogram showing thoracic aorta aneurysm. (C) Computed tomography angiogram showing abdominal aortic aneurysm with a focal saccular aneurysm in the infrarenal part with periaortic stranding (arrow).

Thoracoabdominal Aneurysm in a Professional Body Builder

To the Editor: A 33-year-old otherwise healthy man presented with worsening epigastric and flank pain for 3 weeks. He denied having vomiting, diarrhea, fever, urinary symptoms, or history of kidney stones. His vital signs were significant for a blood pressure of 140/72 mm Hg and pulse rate of 94 beats/min. Acute coronary syndrome was excluded by electrocardiography. A […]

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(A) Clinical course of our patient. (B) Computed tomography revealed massive splenomegaly and irregular low-density area within the spleen. (C) Bone marrow aspirate (×400). (D) Immunohistochemical staining findings of the spleen (×400). LD and LDH = lactate dehydrogenase; RCC = red cell concentrate; R-CHOP = rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone; T-Bil = total bilirubin.

Steroid-Refractory Autoimmune Hemolytic Anemia with Massive Splenomegaly

To the Editor: A 63-year-old woman was admitted in January 2012 with a 1-month history of general fatigue and jaundice. Physical examination revealed a pale conjunctiva, icteric sclera, and splenomegaly with no evidence of systemic lymphadenopathy. Laboratory findings revealed normocytic anemia (49 g/L) with increased reticulocyte count, decreased haptoglobin level, normal white cell count without […]

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