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The rash began on her lower extremities and progressed to cephalad

A 55-year-old female from El Salvador presents with this mildly pruritic and painful rash. No systemic symptoms and labs unremarkable, as well as various serologies. Started on 60mg prednisone with minimal improvement and awaiting biopsy results.

What’s in your differential?

“He was confused, too weak to walk, and crawling on the floor”

A recently married 27-year-old male is brought to the emergency department by his wife for a five-day history of worsening fever, coughing, and shortness of breath. She says he was complaining of abdominal discomfort two days earlier. He’s also had diarrhea for the last two days. What’s your next step?

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What will exacerbate this patient’s condition?

A 70-year-old male with a history of hypertension presents with a fever and severe pain in both his hands. Examination reveals swollen, erythematous, and tender nodules on the joints of his fingers. Arthrocentesis demonstrates negatively birefringent urate crystals in the synovial fluid. What is most likely to exacerbate this patient’s condition?

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These cases were originally published in the July 18, 2019 edition of The Differential for Primary Care newsletter. The Differential is our premium newsletter which rounds up the most interesting and useful clinical cases based on your specialty. To sign up for this email in any of its 10 specialty-specific editions, download the Figure 1 app and update your email preferences.