You are correct. The patient had Cushing syndrome secondary to exogenous corticosteroid use. She had been applying a steroid-containing skin whitener + topical 0.05% clobetasol for the past 10 yrs. A morning cortisol was suppressed at 11 nmol/L (ref: 171-536 nmol/L). Two months later, off all corticosteroids, morning cortisol and ACTH were normal, and she was off insulin and antihypertensives.

You are correct. This patient acquired an arterial air embolism during radial artery catheterization during arterial blood gas analysis. The nurse immediately noticed that air had been entrained in the tubing and removed the line promptly. The patient’s signs and symptoms resolved spontaneously within a few minutes.

You are correct. Histology and immune studies confirmed metastatic melanoma. CT showed lung, adrenal, and cerebral mets, but skin exam was normal. Histological review of a nevus excised 6 yrs prior revealed a subtle melanoma, not appreciated originally. GI involvement occurs in 60% of metastatic melanoma pts w/ only 4% diagnosed before death. Initial presentation w/ duodenal mets is unusual; typical sx may include pain, bleeding, and obstruction.

You are correct. Acne neonatorum, also known as neonatal cephalic pustulosis, is a benign, self-limited rash that presents shortly after birth. Acneiform papules and pustules are located on the cheeks, forehead, and, sometimes, chest. Herpes lesions, in contrast, are vesicular. Group A strep infection is usually associated with signs of sepsis. Neonatal pustular melanosis typically affects the entire body including palms and soles. Atopic dermatitis is often itchy and doesn't present until after 3 mos of life.

You are correct. Real-time PCR for viral DNA revealed human herpesvirus 6 (HHV-6) infection; other serological tests and cultures were negative. Three days after admission, the skin lesions completely resolved. Antibiotic therapy was stopped and patient was discharged. At 1-mo follow-up, HHV-6 DNA had decreased and the infant remained well without recurrence of rash.

You are correct. Hemophagocytic lymphohistiocytosis (HLH) is also known as macrophage activation syndrome, or reactive hemophagocytic syndrome. HLH is a syndrome of excessive macrophage activation often triggered by a viral infection in immunosuppressed pts. Activated macrophages phagocytose blood cell precursors, causing pancytopenia. HLH is treated with prompt immunosuppression, supportive care, and tx of the underlying infection. This patient made a full recovery after immunosuppressive and antiviral tx.

You are correct. Herpes zoster is usually confined to a single, unilateral dermatome. This patient had typical vesicular zoster eruption simultaneously in dermatomes D8 and L4, perhaps due to her immunosuppression. She was treated with IV acyclovir 10 mg/kg TID with gradual improvement and crusting of lesions. She was free of recurrence at 2 mo follow-up.