Medical Images
Acute Esophageal Necrosis Presenting as Acute Blood Loss Anemia
An elderly male with coronary artery disease as well as atrial fibrillation on rivaroxaban presented following a syncopal episode. Workup revealed acute non–ST-elevation myocardial infarction. Aspirin and clopidogrel were administered followed by coronary angiography. Twelve hours after his procedure, he developed delirium, fever, tachycardia, and hypotension. Urgent chest computed tomography revealed acute subsegmental pulmonary emboli for which heparin drip was initiated. Empiric antibiotics were also started due to concern for sepsis; ultimately, no infectious source was identified.Mounier-Kuhn With Multiple Diverticula
A male in his 60s, nonsmoker, with history of gastroesophageal reflux disease, hiatal hernia repair, and recurrent bronchitis presented to an otolaryngology subspecialty clinic with 1 month of mild dyspnea. Office bronchoscopy identified a paratracheal diverticulum and abnormal scar tissue in the mainstem bronchi bilaterally. The trachea demonstrated posterior scar bands with intermittent dilations (Figure 1). Computed tomography (CT) imaging revealed a 44×18–mm cystic, extrapulmonary lesion along the right side of the trachea, as well as tracheobronchomegaly (Figure 2).Polypoid Corditis: Reinke Edema of the Larynx
Polypoid corditis (also called Reinke edema) is a benign condition that arises in chronic smokers. The Reinke space is the loose connective tissue directly subjacent to the basement membrane of the squamous-lined true vocal fold. Devoid of glandular tissue and lymphatic channels, this area is prone to react to trauma, either due to smoke, excessive phonation, or otherwise. Given the lack of lymphatic channels, the tissue may become edematous with increased vascularization, so-called Reinke edema, and may manifest clinically as a polypoid projection into the airway.Shiitake Flagellate Dermatitis
A man in his early 70s presented with a 3-day history of intensely pruritic erythematous papules and papular vesicular eruption arranged in a flagellate pattern on his neck, trunk, (Figure 1), and extremities with no general symptoms. On questioning, he had eaten undercooked shiitake mushrooms 2 days before the onset of the cutaneous lesions. Laboratory investigation was unremarkable. A skin biopsy revealed spongiosis, marked papillary dermal edema, and a dermal perivascular inflammatory infiltrate mainly composed of lymphocytes and eosinophils.Thyroid Dermopathy and Acropachy
A 58-year-old man with a 9-year history of gradually worsening and disabling hand and feet swelling, with associated burning pain, is followed in Dermatology. He developed Graves disease 20 years ago, treated with radioactive iodine, and Graves ophthalmopathy treated with surgical decompression and tarsorrhaphy 8 years ago. He is a former smoker. Examination revealed disfiguring hypertrophic, firm, skin-colored overgrowth, and nonpitting edema of hands (Figure 1; Supplemental Figure, available online at http://www.mayoclinicproceedings.org ) and feet (Figure 2).Pustular Psoriasis
A woman in her 60s with no past dermatologic history presented with a 4-month history of a pustular eruption. Before onset she had received steroid injections for cervical radiculopathy, but there were no other new medications or illnesses. Dermatologic exam showed more than 90% body surface area involvement with erythematous patches studded with pustules and diffuse skin sloughing (Figure 1) (Supplemental Figure 1, available online at http://www.mayoclinicproceedings.org ). Skin biopsy specimens showed subcorneal neutrophilic pustules with hypogranulosis (Figure 2).Disseminated Bullous Impetigo in an Adult With Atopic Dermatitis Flare
A man in his mid-20s with a history of atopic dermatitis presented to the emergency department with a 1-week history of a worsening painful and pruritic generalized rash. Examination revealed erythematous erosions on the trunk and limbs with shallow bullae (Figure 1; Supplemental Figure 1, available online at http://www.mayoclinicproceedings.org ) and absence of Nikolsky sign.Linear IgA Bullous Dermatosis in Association With Crohn Disease
A man in his 50s with a 3-year history of Crohn disease presented with a 1-week history of pruritic blistering on the trunk and extremities. Examination revealed tense vesicles arranged in annular pattern on the nape, upper back, and extensor side of the upper arms (Figure 1). No new medications were initiated in the past 3 months, including antibiotics, angiotensin-converting enzyme (ACE) inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). A skin biopsy from the right upper arm showed a subepidermal blister with neutrophilic infiltrates at the basement membrane and papillary dermis.
