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  • Unknown etiology and pathogenesis, but EAC has been associated with other medical conditions, such as fungal infections (in 72% of cases),1 malignancy, and other systemic illness. Few case reports have reported the diagnosis of cancer 2 years after presentation of EAC.2
  • Other infections identified as triggers for EAC include bacterial infections such as cystitis, appendicitis, and tuberculosis (TB); viral infections such as Epstein-Barr virus (EBV), molluscum contagiosum, and herpes zoster; and parasites, such as Ascaris.2
  • Certain drugs, such as chloroquine, hydroxychloroquine, estrogen, cimetidine, penicillin, salicylates, piroxicamhydrochlorothiazideamitriptyline, lenalidomide, finasteride, and etizolam, can also trigger EAC.2-6
  • Systemic diseases involving the liver, dysproteinemias, autoimmune disorders, HIV, and pregnancy are associated with EAC by various case reports.2,7,8
  • Because injections of Trichophyton, Candida, tuberculin, and tumor extracts have been reported to induce EAC, a type IV hypersensitivity reaction is thought to be one possible mechanism for its development.8




A hordeolum is an acute painful infection of the glands of the eyelid, usually caused by bacteria. Hordeola can be located on the internal or external eyelid. Internal hordeola that do not completely resolve become cysts called chalazia. External hordeola are commonly known as styes.



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The treatment of HBV-GN revolves around antiviral therapy.


Complications of Injecting Drug Use

  • Local problems—Abscess (Figures 240-2 
    Image not available.

    A 32-year-old woman with type 1 diabetes developed large abscesses all over her body secondary to injection of cocaine and heroin. Her back shows the large scars remaining after the healing of these abscesses. (Courtesy of ­Richard P. Usatine, MD.)

    and 240-3; Abscess), cellulitis, septic thrombophlebitis, local induration, necrotizing fasciitis, gas gangrene, pyomyositis, mycotic aneurysm, compartmental syndromes, and foreign bodies (e.g., broken needle parts) in local areas.2
    • IDUs are at higher risk of getting methicillin-resistant Staphylococcus aureus(MRSA) skin infections that the patient may think are spider bites (Figure 240-4).
    • Some IDUs give up trying to inject into their veins and put the cocaine directly into the skin. This causes local skin necrosis that produces round atrophic scars (Figure 240-5).
  • IDUs are at risk for contracting systemic infections, including HIV and hepatitis B or hepatitis C.
    • Injecting drug users are at risk of endocarditis, osteomyelitis (Figures 240-6and 240-7), and an abscess of the epidural region. These infections can lead to long hospitalizations for intravenous antibiotics. The endocarditis that occurs in IDUs involves the right-sided heart valves (see Chapter 50, Bacterial Endocarditis).2 They are also at risk of septic emboli to the lungs, group A β-hemolytic streptococcal septicemia, septic arthritis, and candidal and other fungal infections.


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A 57-year-old farm worker presents with itchy red rings on his body that have come and gone for more than 13 years (Figures 206-1 and 206-2).

The erythematous annular eruption was visible on his abdomen, legs, and arms. Figure 206-2 shows the typical “trailing scale” of erythema annular centrifugum (EAC). A KOH preparation was negative for fungal elements and the patient was given the diagnosis of EAC. He recently began using paint thinner to “dry out the rash” and decrease the itching. Because topical steroids did not provide any relief for him in the past, we offered the option of using calcipotriol ointment. He chose to try the calcipotriol and stop using paint thinner.

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Question 1 of 1

A 42-year-old African-American man has been diagnosed with hypertension for the past 10 years and treated with medication. One morning, he is found unresponsive by his wife. He is taken to the emergency department and pronounced dead by the physician. An autopsy revealed cardiac hypertrophy and a narrowing of the aorta just distal to the ligamentum arteriosum, with dilation of the intercostal artery's ostia. How could the death have possibly been prevented?



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