IMAGES IN CLINICAL MEDICINE Minocycline-Induced Hyperpigmentation Aarti Maharaj, Michael Omar N Engl J Med 2026;394: e24 DOI: 10.1056/NEJMicm2513782 A 68-year-old woman with rosacea presented to the cardiology clinic with a 6-week history of dark patches on the skin of her arms and legs. Two weeks before the onset of the skin changes, she had started taking 100 mg daily of oral minocycline to treat rosacea. The dark patches, which had first appeared on ...

IMAGES IN CLINICAL MEDICINE Massive Intravascular Hemolysis from Clostridium perfringens Bacteremia Ann Tran, Carol Lee N Engl J Med 2026;394: e19 DOI: 10.1056/NEJMicm2514135 A 73-year-old woman with type 2 diabetes presented to the emergency department with a 1-day history of malaise, dyspnea, and confusion. Vital signs and physical examination indicated shock. Serum laboratory samples were obtained, but they could not be processed owing to g...

When the heart goes to the wrong side Mabuchi, S., Minami, K. & Takeuchi, M When the heart goes to the wrong side. Intensive Care Med (2026). https://doi.org/10.1007/s00134-026-08321-9 Cardiac herniation is a rare but potentially serious complication that can occur when the pericardium is left unclosed after cardiac surgery, particularly following minimally invasive thoracotomy approaches (Fig. 1). Diagnosis is primarily based on postoperative imaging fin...

IMAGES IN CLINICAL MEDICINE Pulmonary Mucormycosis Jonas Lötscher, Justus Baarts N Engl J Med 2026;394:699 A 49-year-old man with acute myeloid leukemia who had been admitted to the hospital for induction chemotherapy was evaluated for prolonged neutropenic fever. On physical examination, crackles were heard at the lung bases. Computed tomography (CT) of the chest revealed rounded opacities with central ground-glass attenuation and ring...

Imaging in Intensive Care Medicine Published: 19 January 2026 Portal venous gas on point-of-care ultrasound van Gastel, L., de Kok, L. Intensive Care Med(2026). https://doi.org/10.1007/s00134-025-08232-1 Abdominal computed tomography (CT) confirmed the presence of portal venous gas and pneumatosis intestinalis in the ileum and ascending colon, with patent mesenteric arteries (Fig. 1, panel A, B and C respectively). Non-occlusive mesenteric ischem...

Imaging in Intensive Care Medicine Ghost cells in Clostridium perfringens liver abscess with massive hemolysis Yoshihiro Nagai, Seiya Nishiyama, Tadashi Kamio, et al Intensive Care Med 2025 https://doi.org/10.1007/s00134-025-08227-y Clostridium perfringens produces phospholipase C, the systemic dissemination of which can lead to severe intravascular hemolysis. Erythrocytes whose cell membranes are lysed lose hemoglobin, and the resulting small, me...

Acute respiratory failure unmasking an unexpected disease Loïc Velten, Anaïs Curtiaud, Antoine Studer, et al Intensive Care Med (2025). https://doi.org/10.1007/s00134-025-08093-8 Relapsing polychondritis (RP) is a rare, immune-mediated disease characterized by recurrent inflammation of cartilaginous structures, including the auricles, nasal cartilage, peripheral joints, and respiratory tract (Fig. 1). It affects both men and women, typically presenting around...

IMAGES IN CLINICAL MEDICINE Complete Heart Block Detected by Consumer-Facing Digital Health Technologies James E. Ip N Engl J Med 2025;393:2254 DOI: 10.1056/NEJMicm2510111 A 70-year-old man with hypertension and coronary artery disease presented to the emergency department with a several-hour history of shortness of breath and a slow heart rate. On the day of presentation, his commercial mattress — which included a ballistocardiographic monitoring featu...

Imaging in Intensive Care Medicine Serum sickness: a mimic of septic shock Takafumi Todaka Intensive Care Med Published: 17 September 2025 https://doi.org/10.1007/s00134-025-08118-2 Serum sickness typically manifests 7–14 days after exposure to heterologous proteins, such as antivenoms, some vaccines, and immune-modulating agents (e.g., rituximab and infliximab). Most cases resolve with withdrawal of the offending agent; however, severe systemic involve...

IMAGES IN CLINICAL MEDICINE Uremic Frost Muzamil Ahmad Wani, Zeeza Hussain Shah N Engl J Med 2025;393:1327 DOI: 10.1056/NEJMicm2507714 A 52-year-old woman with hypertension presented to the hospital with a 1-month history of fatigue, as well as 6 days of vomiting and 1 day of confusion. Over the past 20 years, she had not received regular treatment for hypertension. Physical examination was notable for pallor of the conjunctiva and o...