NEJM Image of the Week

• Tattoo Allergy

  A 40-year-old man presented with intractable pruritus within portions of a tattoo imprinted with red ink on the left leg (Panel A). The intense localized itching had begun approximately 4 months after placement of the . . .

• Lipomatosis of the Tongue

  An 88-year-old man presented with diffuse, painless swelling of the lateral borders of his tongue (Panel A). The swelling had been slowly increasing during the previous 20 years. Yellowish tumors with a smooth, shiny . . .

• Perforated Umbilical Hernia

  A 68-year-old man with alcoholic cirrhosis, portal hypertension, ascites, and an umbilical hernia presented to the emergency department after an episode of coughing that was followed by a rush of fluid and fat from the . . .

• Graves' Hyperthyroidism

  A 42-year-old woman presented with palpitations, anxiety, tremor, and weight loss. She had received a diagnosis of Graves’ disease 15 years previously but had discontinued therapy more than 5 years previously. Over the ensuing years . . .

• Infection 57 Years after Plombage

  An 86-year-old man was hospitalized for repeated episodes of septic shock due to methicillin-resistant Staphylococcus aureus (MRSA) pneumonia; he ultimately died of pseudomonal sepsis and pneumonia. In 1948, the patient had pulmonary tuberculosis and . . .

• Tongue Necrosis in a Patient with Essential Thrombocytosis

  A 69-year-old woman with complete atrioventricular block was admitted for implantation of a pacemaker. Her medical history included multiple sclerosis with tetraparesis. She had been taking acenocoumarol for the previous 10 years for the treatment . . .

• Patulous Eustachian Tube and Eustachian-Tube Dysfunction

  A 36-year-old woman presented with a 4-year history of intermittent bilateral aural fullness, subjective hearing loss, and popping and crackling tinnitus with autophony of the left ear. Aural symptoms were sometimes relieved by positional changes, . . .

• White Tongue

  A 55-year-old male nonsmoker with multiple myeloma refractory to chemotherapy was admitted to the hospital for autologous stem-cell transplantation. Palifermin was to be administered before and after the transplantation. On completion of the 3-day infusion . . .

• Fecaliths in Crohn's Disease

  A 74-year-old man presented with a 5-day history of diffuse abdominal pain, constipation, nausea, and vomiting. His abdomen was tympanitic without peritoneal signs. Radiography of the abdomen revealed a dilated small intestine that was consistent . . .

• Chvostek's Sign and Carpopedal Spasm

  A 35-year-old man presented with a 2-day history of cramps and paresthesias in the arms, predominantly involving the fingers. This presentation was preceded by a bout of viral gastroenteritis 1 week earlier. The patient reported . . .