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The hottest chili pepper in the world made for the most engaging case of the month on Figure 1. The Carolina Reaper joins a tarantula-hair injury, a rare complication of a pneumonia, and a swallowed coin as April’s top medical cases.

The world’s healthcare professionals come to Figure 1 every day to share what they’re seeing and sharpen their clinical skills. Every month, we compile the best cases they’ve contributed, based on:

Community Metrics: The number of times they were viewed, discussed, and shared by the more than 2M healthcare professionals on the platform.

Clinical Value: Our medical and community teams assess the quality, complexity, and educational merit of our top cases to highlight the most credible and clinically useful material.

April’s top cases were shared by an Ivy league university, a leading journal, and a Brazilian physician, among others. Together, they show the breadth and depth of modern healthcare.

1. The Carolina Reaper

The world’s hottest chili pepper is said to be the Carolina Reaper, a variety that clocks in an average of 1.5 million Scoville Heat Units. A 34-year-old man presented to the emergency room following an episode of  thunderclap headache after consuming the Reaper, and a detailed case report was shared on Figure 1 by the BMJ.

“A presumptive diagnosis of thunderclap headache secondary to reversible cerebral vasoconstriction syndrome (RCVS) was made,” the journal wrote. “No cases of RCVS secondary to peppers or cayenne have been previously reported, but ingestion of cayenne pepper has been associated with coronary vasospasm and acute myocardial infarction.”

2. “No more furniture moving!”

After helping a friend move furniture, a 71-year-old man came to hospital with hip and back pain and X-rays were performed. The radiographic findings startled the medical community.
“Wow,” commented a top orthopedic surgeon. “End stage arthritis hip joint which can cause thigh and glute pain. Add degenerative scoliosis lumbar spine, loss lumbar lordosis, multiple disc space degeneration, facet arthritis, foraminal encroachment lower levels, large osteophytes. All aggravated by moving furniture.”
The surgeon went on to explain his thinking and offer feedback on a course of treatment.
“Start conservatively and instruct patient–no more furniture moving!” the surgeon said.

3. A rare diagnosis of necrotizing pneumonia

The Emergency Medicine Residency Program at Brown University maintains a popular Figure 1 account on which they share teaching cases and link back to their blog. This case featured a 2-year-old girl who presented to the emergency department with fever and a cough. Following a chest x-ray and lung ultrasound she was diagnosed with necrotizing pneumonia,  a rare and serious complication of pneumonia . The Brown account was able to offer some good news in the discussion: “To make a long story short, she was taken to the OR for VATS, had 2 chest tubes placed, covered with antibiotics, and ultimately did very well.”

4. The hair of a deadly tarantula

“A 67‐year‐old man who made insect specimens was accidentally injured by tarantula hair and presented with acute onset of swelling, stinging and a blackish colour change on the fingertip.” So reported the British Journal of Dermatology in this fascinating case, which documented the contact dermatitis caused by such an injury.

5. A clinical pearl about X-ray

X-rays of coins ingested by children  are shared every month on Figure 1, but this case of a 4-year-old boy who swallowed two coins stands out because of the valuable clinical pearl shared  in the discussion.
“Mom states he swallowed 2 pennies,” said the registered nurse who shared the case. “No signs of distress. lungs clear and equal bilaterally. … Unsure if the size is correct to be a penny.”

To which an emergency medicine physician responded:

“Recall that X-ray will magnify objects not adjacent to the film, so measurements not helpful unless too small.”

The patient was discharged with home observation and instructions to watch for the passage of the coins in his stool.


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