JAMA Diagnostic Test Interpretation  August 21, 2023 Multistep Testing Algorithms for Clostridioides difficile Infection Maribeth R. Nicholson, Curtis J. Donskey JAMA. Published online August 21, 2023. doi:10.1001/jama.2023.15875 Case A10-year-old female with spina bifida and neurogenic bowel was hospitalized for abdominal pain, dehydration, and more than 20 episodes of watery diarrhea per day. Her symptoms be...

Teachable Moment  August 14, 2023 Mild Transaminase Elevation With Rapid Diagnostic Escalation: A Teachable Moment Priyal Gandhi, Niloofar Latifi JAMA Intern Med. Published online August 14, 2023. doi:10.1001/jamainternmed.2023.3884 Story From the Front Lines A33-year-old woman with well-controlled hypertension and body mass index of 21 (calculated as weight in kilograms divided by height in meters squared) presented to primary care for fo...

JAMA Diagnostic Test Interpretation  August 21, 2023 Multistep Testing Algorithms for Clostridioides difficile Infection Maribeth R. Nicholson, Curtis J. Donskey JAMA. Published online August 21, 2023. doi:10.1001/jama.2023.15875 Case A10-year-old female with spina bifida and neurogenic bowel was hospitalized for abdominal pain, dehydration, and more than 20 episodes of watery diarrhea per day. Her symptoms began 5 days after com...

IMAGES IN CLINICAL MEDICINE Superior Mesenteric Artery Syndrome Thibault Kerdiles, Julien Gras N Engl J Med 2023; 389:359DOI: 10.1056/NEJMicm2213146 A 26-year-old man from Somalia presented to the emergency department with a 5-month history of dry cough, night sweats, and unintentional weight loss of 18 kg. During this period, epigastric pain and episodes of postprandial vomiting had also developed. His body-mass index (the weight in kilograms divided by t...

Challenges in Clinical Electrocardiography  March 13, 2023 Computer-Estimated Heart Rate vs True Heart Rate—Be Aware of the Software Laszlo Littmann JAMA Intern Med. Published online March 13, 2023. doi:10.1001/jamainternmed.2022.6613 Case Presentation Apatient in their 60s was admitted to the intensive care unit for gastrointestinal bleeding and shock associated with liver cirrhosis, portal hypertension, and ruptured esophageal varices. E...

IMAGES IN CLINICAL MEDICINE Periorbital Edema in Dermatomyositis Caoilfhionn M. Connolly, Lisa Christopher-Stine N Engl J Med 2023; 388:e52DOI: 10.1056/NEJMicm2210861 A 61-year-old woman presented to the rheumatology clinic with a 6-month history of periorbital swelling and shoulder weakness. She reported no dyspnea, cough, or joint pain. The physical examination was notable for erythema of the upper and lower eyelids and substantial periorbital edema (Pan...

IMAGES IN CLINICAL MEDICINE Coffee Bean Sign in Cecal Volvulus Pascal Gavriilidis, Francisco Reyes Milian N Engl J Med 2023; 388:1415DOI: 10.1056/NEJMicm2210796 An 87-year-old man with chronic kidney disease, hypertension, and atrial fibrillation presented to the emergency department on a remote South Atlantic island where he resided with a 3-day history of constipation and lower abdominal pain. The patient’s body temperature was 39.2°C, the heart rate was...

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...