Teachable Moment  Less Is More February 20, 2023 Safely Prescribing Nirmatrelvir and Ritonavir—Avoiding Drug-Drug Interactions Roshni Culas, Sridesh Nath, Sarath Nath JAMA Intern Med. 2023;183(4):362-363. doi:10.1001/jamainternmed.2022.6834 Story From the Front Lines A72-year-old man called his primary care physician (PCP) after 2 days of throat pain, myalgia, mild shortness of breath, and fever. A home COVID-19 antigen test result was positive. ...

IMAGES IN CLINICAL MEDICINE “Hairy Kidney” in Erdheim–Chester Disease Nityasree Srialluri, Mohamed G. Atta N Engl J Med 2023; 388:925DOI: 10.1056/NEJMicm2208776 A 62-year-old man undergoing abdominal ultrasonography for the evaluation of gallstones was found to have a retroperitoneal mass. A physical examination and the results of routine laboratory studies, including tests of renal function, were normal. A computed tomographic (CT) urogram showed soft-tis...

IMAGES IN CLINICAL MEDICINE Pseudothrombocytosis Konstantinos Liapis, Stavros Papadakis N Engl J Med 2023; 388:746DOI: 10.1056/NEJMicm2209299 An 80-year-old woman who had been admitted to the intensive care unit (ICU) with severe burns was noted to have an elevated platelet count. She had been rescued from a house fire and admitted to the ICU for the management of second- and third-degree burns involving 55% of her body-surface area. On presentation, labor...

IMAGES IN CLINICAL MEDICINE Bilothorax Yu Kurahara, Ikue Nagayama N Engl J Med 2023; 388:e17DOI: 10.1056/NEJMicm2206943 A 77-year-old man with metastatic lung adenocarcinoma presented to the emergency department with a 2-week history of dyspnea. Examination was notable for reduced breath sounds at the right lung base. A chest radiograph showed a pleural effusion on the right side (Panel A). An abdominal ultrasound image showed previously known liver metast...

IMAGES IN CLINICAL MEDICINE Cerebral Cystic Echinococcosis Sumit Thakar, Akhil Sunil N Engl J Med 2023; 388:e10DOI: 10.1056/NEJMicm2208104 A previously healthy 14-year-old boy who lived on a farm presented with a 1-month history of episodic headaches associated with vomiting. Physical examination was notable for papilledema. Magnetic resonance imaging of the head showed a multiloculated cyst measuring 6.0 cm by 6.2 cm by 5.8 cm in the right temporoparietal...

IMAGES IN CLINICAL MEDICINE Cerebral Alveolar Echinococcosis Hu Ju, Chuanchuan Liu N Engl J Med 2023; 388:453DOI: 10.1056/NEJMicm2202196 A 17-year-old boy presented to the emergency department with a 3-week history of dizziness, headache, and weakness of the right leg. Neurologic examination was notable for 4/5 strength in the right lower leg. Computed tomography (CT) of the head revealed ring-enhancing lesions in the frontal lobe and basal ganglia on the ...

IMAGES IN CLINICAL MEDICINE Splenic Tuberculosis Chung-Yen Chen, Po-Jen Yang N Engl J Med January 21, 2023DOI: 10.1056/NEJMicm2206174 A 29-year-old man with human immunodeficiency virus (HIV) infection presented to the emergency department with a 2-week history of abdominal pain on the left side. Six months before presentation, he had received a diagnosis of HIV infection and non–drug-resistant pulmonary tuberculosis, for which antiretroviral and four-drug...

Endgames Christmas 2022: Brain Stew Electrocardiogaffe Patricia McGettigan, Ian C Cooper, Jennifer H Martin, et al BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2022-074083 (Published 19 December 2022)Cite this as: BMJ 2022;379:e074083 Because a physician has possessed himself of an electrocardiograph, a polygraph, an x-ray machine, a blood pressure instrument, or some ingenious form of stethoscope, it does not at...

Endgames Christmas 2022: Brain Stew Electrocardiogaffe Patricia McGettigan, Ian C Cooper, Jennifer H Martin, et al BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2022-074083 (Published 19 December 2022)Cite this as: BMJ 2022;379:e074083 Because a physician has possessed himself of an electrocardiograph, a polygraph, an x-ray machine, a blood pressure instrument, or some ingenious form of stethoscope, it does not at all follow that he has become competent...

JAMA Diagnostic Test Interpretation  November 10, 2022 Peritoneal Fluid Analysis in Peritoneal Dialysis–Associated Peritonitis Jeffrey Perl, Ziv Harel, Sharon J. Nessim JAMA. Published online November 10, 2022. doi:10.1001/jama.2022.21289 Case A62-year-old woman undergoing peritoneal dialysis (PD) for kidney failure due to IgA nephropathy presented to the PD clinic with a 1-day history of severe abdominal pain...