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A correction has been published: N Engl J Med 2003;349(19):1880.

A correction has been published: N Engl J Med 2004;350(6):629.

Clinical Problem-Solving
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Volume 349:1465-1469 October 9, 2003 Number 15
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Mind the Gap
Alexander Turchin, M.D., Julian L. Seifter, M.D., and Ellen W. Seely, M.D.

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In this Journal feature, information about a real patient is presented in stages (boldface type) to expert clinicians from several specialties, who respond to the information, sharing their reasoning with the reader (regular type). The authors' commentary follows.

A 62-year-old woman was admitted to the hospital because of abnormal liver-function tests. She had a history of acute myelogenous leukemia and had undergone transplantation of T-cell–depleted allogeneic bone marrow two years earlier. The patient had had mildly increased aminotransferase levels since the transplantation. Four months before admission, the levels of alkaline phosphatase and bilirubin became elevated, presumably because of chronic graft-versus-host . . . [Full Text of this Article]

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From the Division of Endocrinology, Diabetes and Hypertension (A.T., E.W.S.), and the Division of Nephrology (J.L.S.), Department of Medicine, Brigham and Women's Hospital, Boston.

Address reprint requests to Dr. Turchin at the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, 221 Longwood Ave., Boston, MA 02115, or at aturchin@partners.org.


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