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A 42-year-old man on prolonged immunosuppressive therapy for chronic graft-versus-host disease after stem-cell transplantation for acute lymphoblastic leukemia presented to clinic with a 2-week history of urinary frequency and weak stream. Physical examination was notable for several small papules on the penile shaft. Urinalysis showed 9 white cells per... show more

NEJM

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A 61-year-old man with prolonged neutropenia as a result of salvage chemotherapy for acute myeloid leukemia was evaluated on hospital day 37 for persistent neutropenic fever despite treatment with broad-spectrum antimicrobial agents. Physical exam was notable for a lesion with central necrosis on the chest and a similar lesion on the left palm. A serum 1,3-β-D-glucan level was elevated, and a galactomannan was negative. Computed tomography of the chest, abdomen, and pelvis was performed. Gram’s staining of blood culture revealed septate, hyaline hyphae. What is the most likely causative organism? Submit your answer or see how others responded:

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Retired U.S. Sergeant and Marshal Arrested for Sending Illicit Messages to a 13-Year-Old Decoy. A retired sergeant who also served as a U.S. Marshal was arrested after exchanging sexually explicit messages with someone he believed was a 13-year-old girl. The encounter was part of a sting operation by a predator poaching group (Decoy Twinkle / Falcon Pursuit Coalition in Illinois). The man showed up expecting to meet the minor, leading to his arrest on related charges. Reports from the sting noted his wife appeared indifferent when informed.

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