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Henoch-Schönlein Purpura in the Adult

Ivan Virovets, DO* and Danielle Biggs, MD*

DOI: https://doi.org/10.21980/J8QH08 Issue 5:1[mrp_rating_result]
The images show a raised, palpable, purpuric rash on the lower extremities, surrounded by a mild, 1+ non-pitting edema. Several of the lesions are exfoliated with serous discharge. There is no surrounding erythema, fluctuance, or lymphangitis to suggest cellulitis. There was no tenderness to palpation; however, pruritus was exacerbated on palpation.
DermatologyCardiology/VascularVisual EM
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Digital Nerve Block for the Reduction of a Proximal Phalanx Fracture of the Foot – a Case Report

Emerald Raney, MD*, John Costumbrado, MD, MPH*, Barbara Blasko, MD* and Dev Dhillon, BS^

DOI: https://doi.org/10.21980/J8KS8T Issue 5:1[mrp_rating_result]
Plain film of the right foot showed evidence of an oblique fracture of the body of the proximal 4th phalanx (image 2). No other acute traumatic injuries noted in the rest of the bones and joints of the right foot. After performing a digital block of the toe and reduction, repeat imaging showed evidence of successful reduction with anatomic alignment and redemonstration of the fracture line (image 3).
Visual EMOrthopedics
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Case Report: Antifreeze Ingestion and Urine Fluorescence

Taras Varshavsky, MD* and Meigra Myers Chin, MD *

DOI: https://doi.org/10.21980/J8G05T Issue 5:1[mrp_rating_result]
The patient’s urine sample (right) was compared to a control (left) using a Wood’s lamp. It revealed light green fluorescence under ultraviolet light, which increased suspicion for ethylene glycol poisoning from antifreeze ingestion.
ToxicologyVisual EM
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Oral Herpes Zoster

Daniel Polvino, MD*, Grant Wei, MD* and Christopher Bryczkowski, MD*

DOI: https://doi.org/10.21980/J8QS69Issue 4:3[mrp_rating_result]
Physical exam findings revealed vesicular lesions on the lip, hard and soft palates which did not cross the midline. The lesions appeared in the distribution of the maxillary branch (V2) of the trigeminal nerve, consistent with herpes zoster.
DermatologyInfectious DiseaseVisual EM
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Brown Recluse Spider Bite

Laryssa A Patti, MD*, Benajamin Landgraf, MD* and Christopher Bryczkowski, MD*

DOI: https://doi.org/10.21980/J8TK99Issue 4:3[mrp_rating_result]
Examination of the skin revealed erythema and induration on the right lateral leg 12 cm in diameter with a 6 cm area of central necrosis and surrounding petechiae without fluctuance or crepitus. The patient was neurovascularly intact distal to the lesion. Laboratory values were within normal limits, except for an elevated C-reactive protein (5.31 mg/dL, normal range <0.70 mg/dL). The patient was diagnosed with ulceration secondary to envenomation from a brown recluse spider.
WildernessVisual EM
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Levamisole Induced, Cocaine Associated Vasculitis

Jaymin Patel, MD*, Jason Mefford, MD^ and John Richards, MD*

DOI: https://doi.org/10.21980/J8K35S Issue 4:3[mrp_rating_result]
An asymmetric pattern of palpable purpura with bullae was noted on bilateral lower extremities with smaller patches on bilateral upper extremities. There was no tenderness or crepitus.
DermatologyCardiology/VascularVisual EM
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Pectoralis Muscle Tendon Rupture

Wyatt Verplaetse, MD* and Gregory Podolej, MD*

DOI: https://doi.org/10.21980/J81D01Issue 4:2[mrp_rating_result]
There is a noticeable difference in appearance and location of maximal prominence of the right pectoral muscle with arms outstretched (image 1). This is accentuated by having the patient perform an isometric arm press. (image 2).There is absence of the anterior axillary fold with adduction against resistance. The stump of the pectoralis muscle was palpated along his armpit.  He otherwise has full range of motion in the shoulder with minimal pain.
Visual EMOrthopedics
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Abdominal Pain with Black Tongue

David A Adler, MD* and Isabel M Algaze Gonzalez, MD^

DOI: https://doi.org/10.21980/J8XS7JIssue 4:1[mrp_rating_result]
Patient’s tongue had a black discoloration, without elongated filiform papillae. We could not appreciate lymphadenopathy. His abdomen was tender to palpation.
ENTVisual EM