Common Symptoms In Internal Medicine

Common Symptoms In Internal Medicine

Learning Outcomes

• After this lecture, you should be able to:

  • List common diagnoses that can potentially cause each symptom.

  • Recognize the life-threatening diagnoses that can potentially cause each symptom.

  • Recognize the features that distinguish between the different causes of the common symptoms.

  • When working out possible differential diagnoses for each symptom, ensure to rule out life-threatening causes before settling on the more benign ones.

Symptoms In Internal Medicine

• Symptoms are subjective experiences or complaints reported by patients.

• They serve as vital clues for clinicians to identify potential health issues.

• Accurate symptom analysis is crucial for making correct diagnoses and developing effective treatment plans.

• Symptoms can range from general to system-specific.

Common Symptoms in Internal Medicine

General Symptoms

• Fever

• Chills

• Night sweats

• Change in appetite

• Sudden weight changes

• Fatigue

• Malaise

• Sleep pattern changes

• Pruritus

• Chest pain

• Palpitations

• Dyspnea

• Dyspnea on exertion

• Orthopnea

• Paroxysmal nocturnal dyspnea

• Pedal swelling

• Intermittent claudication

Cardiovascular Symptoms

• Chest pain/discomfort

  • Potential causes include:

  • Stable angina

  • Acute Coronary Syndrome

  • Aortic Dissection

  • Coronary vasospasm

  • Pericarditis

  • Cardiac tamponade

  • Myocarditis

  • Aortic stenosis

  • Tachyarrhythmias

• Dyspnea

• Palpitations

Respiratory Symptoms

• Cough

  • Sputum production

  • Hemoptysis

• Chest pain

• Dyspnea

• Exercise tolerance

• Wheeze

Gastrointestinal Symptoms

• Appetite changes

• Nausea

• Emesis

  • Hematemesis

  • Coffee ground emesis

• Dysphagia

• Odynophagia

• Dyspepsia

• Abdominal pain

• Abdominal distension

• Jaundice

• Change in bowel habits

  • Stool color/caliber changes - constipation/diarrhea

  • Melena stool

  • Hematochezia

Endocrine Symptoms

• Limb weakness

• Light-headedness/Dizziness/Vertigo/Fainting

• Numbness or tingling of hands & feet

• Tremors

• Memory loss

• Confusion

• Changes in sleep

• Speech disorders

• Poor balance

• Seizures

• Blurred or loss of vision

• Diplopia

• Loss of smell or taste

• Headaches

• Neck pain and/or stiffness

• Tinnitus

• Polyphagia

• Polyuria

• Polydipsia

• Heat or cold intolerance

• Weight gain or loss

• Menstrual irregularities

• Anterior neck swelling

• Tremulousness

• Irritability

Neurological Symptoms

• Headaches

• Gait abnormalities

• Memory loss

• Muscle weakness

• Dizziness

• Syncope

• Tremors

Genitourinary Symptoms

Urinary Symptoms

• Flank pain

• Frequency

• Nocturia

• Urgency

• Difficulty starting stream

• Incontinence

• Hematuria

• Dysuria

• Passage of stone in the urine

Female Genital Symptoms

• Ulcers

• Rash

• Vaginal discharge/itching

• Menstruation history:

  • Age at menarche

  • Interval between menses

  • Duration of menses

  • Amount of flow

  • Last menses

  • Bleeding between periods

• Age at menopause

• Menopausal symptoms

• Postmenopausal bleeding

Male Genital Symptoms

• Ulcers

• Rash

• Urethral discharge

• Erectile dysfunction

• Loss of libido

• Testicular swelling or pain

Dermatology Symptoms

• Rashes

• Dry skin

• Itching

• Easy bruising

• Lumps and bumps

• Hypo/hyper-pigmentation

• Loss of hair

• Mouth ulcers

Musculoskeletal Symptoms

• Muscle weakness

• Muscle pain

• Joint pain

• Joint swelling

• Joint stiffness/restricted mobility

Psychiatric Symptoms

• Depression

• Anxiety

• Mood swings

• Insomnia

• Irritability

Causes of Symptoms in Internal Medicine

• There are many potential reasons for each symptom encountered in Internal Medicine.

• Some symptoms are system-specific, while others may be due to two or more systems.

• When evaluating symptoms, always analyze them with associated symptoms and consider all life-threatening causes.

• Common causes include, but are not limited to, those discussed in this lecture.

Differential Diagnoses for Common Symptoms

General Symptoms

Fatigue

• Potential causes include:

  • Cancers (e.g., lung, prostate, breast, colorectal)

  • Anemia

  • Diabetes mellitus

  • Hypothyroidism

  • Addison’s disease

  • Cushing's syndrome

  • Hyperparathyroidism

  • Cardiac, renal, or liver failure

  • Cirrhosis

  • COPD

  • IBD

  • HIV

  • RA/SLE

  • Viral illness/post-viral infection

  • Malabsorption syndrome

  • Chronic fatigue syndrome

  • Fibromyalgia

  • Lyme disease

  • Personal circumstances (e.g., poor sleep, stress)

  • Iatrogenic causes (e.g., drugs like beta blockers)

  • Depression/Anxiety

  • Sleep apnoea

  • Eating disorders

  • Drugs and substance abuse

Unintentional Weight Loss

• Potential causes include:

  • Primary or secondary malignancy

  • Infection (e.g., HIV, tuberculosis)

  • Inflammatory conditions (e.g., connective tissue disease such as SLE, RA)

  • Endocrine disease (e.g., hyperthyroidism)

  • Chronic diarrhea

  • Malabsorptive syndrome

  • Anorexia nervosa

  • Depression

Unintentional Weight Gain

• Potential causes include:

  • Hypothyroidism

  • Cushing's syndrome

  • Edema (CHF, CKD, CLD)

  • Drugs (e.g., antipsychotics, OCPs, steroids, insulin, sulfonylureas, Dolutegravir)

  • Menopause

  • PCOS

Fever

• Potential causes include:

  • Infections (e.g., malaria, tuberculosis, abscesses, infective endocarditis)

  • Malignancies

  • Inflammatory disorders (e.g., RA, SLE, PAN, GCA, WG, RF, Vasculitis)

  • Miscellaneous e.g., drug fever

Night Sweats

• Potential causes include:

  • Infection (e.g., TB, HIV, infective endocarditis, osteomyelitis, abscesses)

  • EBV and CMV infections

  • Malaria

  • Malignancies (e.g., HL, NHL, CML, CLL, solid tumors)

  • Drugs

  • Hyperthyroidism

  • Nocturnal hypoglycemia

  • Menopause

  • Brucellosis

  • Fungal infections (e.g., histoplasmosis, coccidioidomycosis, blastomycosis)

Lymphadenopathy

• Causes include:

  • Infections (bacterial, viral, fungal, parasitic)

  • Malignancies (e.g., leukemia, lymphoma, metastatic)

  • Endocrine disorders (e.g., thyroid disorders, adrenal insufficiency)

  • Severe hypertriglyceridemia

  • Amyloidosis

  • PBC

  • RA, SLE, sarcoidosis, MCD, SS

  • Vasculitis (e.g., Churg-Strauss syndrome)

  • Drugs (e.g., atenolol, hydralazine, phenytoin, carbamazepine, allopurinol)

Generalized Pruritus

• Potential causes include:

  • Malignancies (e.g., NHL, HL, leukemia, polycythemia vera)

  • Iron deficiency anemia

  • Cholestasis

  • PBC

  • Hepatitis C infection

  • HIV infection

  • Parasitic infestation

  • Hyperthyroidism and hypothyroidism

  • Diabetes mellitus

  • CKD

  • Drugs

  • Xerosis

  • Depression

  • Aging

Hair Loss

• Causes include:

  • Non-scarring alopecia (e.g., alopecia areata, drug-related hair loss, systemic illnesses such as iron deficiency anemia, vitamin B12 deficiency, anorexia nervosa, HIV)

  • Scarring alopecia (e.g., discoid lupus, severe bacterial or fungal infections)

Cardiorespiratory Symptoms

Chest Pain/Discomfort

• Cardiovascular potential causes include:

  • Stable angina

  • Acute coronary syndrome

  • Aortic dissection

  • Coronary vasospasm

  • Pericarditis

  • Cardiac tamponade

  • Myocarditis

  • Aortic stenosis

  • Tachyarrhythmias

• Respiratory causes include:

  • Pneumonia

  • Pulmonary embolism

  • Pleurisy

  • Pneumothorax

  • Asthma exacerbation

  • Pulmonary hypertension

  • Lung cancer

• Gastrointestinal causes include:

  • Gastroesophageal reflux disease

  • Esophagitis

  • Esophageal spasm

  • Esophageal rupture

  • Gastritis

  • Peptic ulcer disease

• Musculoskeletal causes include:

  • Costochondritis

• Miscellaneous causes include:

  • Severe anemia

  • Herpes zoster

Dyspnea

• Potential causes include:

  • Acute/subacute:

  • Asthma

  • Pneumonia

  • Acute pulmonary edema

  • Acute coronary syndrome

  • Pulmonary embolism

  • Pneumothorax

  • Chronic (defined as dyspnea lasting longer than one month):

  • Lung malignancy

  • COPD

  • Interstitial lung disease

  • Chronic heart failure

  • Pulmonary hypertension

  • Anemia

Palpitations

• Cardiac causes include:

  • Atrial fibrillation

  • Ventricular tachycardia

  • Supraventricular tachycardia

  • Ectopic beats

• Non-cardiac causes include:

  • Thyrotoxicosis

  • Anemia

  • Pheochromocytoma

  • Anxiety

  • Stimulants

  • Depression

  • Drugs

Cough

• Potential causes include:

  • Acute (lasting < 3 weeks):

  • URTI/postnasal drip

  • Pneumonia

  • ACE inhibitors

  • Sub-acute (lasting 3-8 weeks):

  • Lung malignancy

  • GERD

  • Sarcoidosis

  • Chronic (lasting > 8 weeks):

  • Asthma

  • COPD

  • Bronchiectasis

• Sputum production potential causes include:

  • Respiratory infections

  • COPD

  • Asthma

  • Smoking

  • Allergies

  • Lung cancer

  • Bronchiectasis

  • Cystic fibrosis

  • Autoimmune disorders (e.g., RA, SLE)

  • ARDS

Hemoptysis

• Possible causes include:

  • Acute bronchitis

  • Lung malignancy

  • Tuberculosis

  • Pulmonary embolism

  • Pneumonia

  • Lung abscess

  • Bronchiectasis

Wheeze

• Common causes include:

  • Asthma

  • Allergic reactions

  • Respiratory infections (e.g., bronchitis, pneumonia)

  • COPD

  • Cystic fibrosis

  • GERD

  • Pulmonary embolism

  • Congestive heart failure

  • Lung cancer

  • Obstructive sleep apnea

Intermittent Claudication

• Typically caused by Peripheral Artery Disease (with atherosclerosis as a major risk factor).

• Spinal claudication (pseudo claudication) is relieved when walking uphill.

• Must consider other mimics such as sciatica, osteoarthritis, musculoskeletal injuries.

Pedal Edema

• Possible causes include:

  • CCF/RVF

  • Cirrhosis of the liver

  • Nephrotic syndrome

  • CKD

  • Hypothyroidism

  • Protein-losing enteropathy

  • Medications.

Gastrointestinal Symptoms

Dysphagia

• Potential causes include:

  • Neuromuscular disorders

  • Stroke

  • Myasthenia gravis

  • Motor neurone disease

  • Obstructive disorders (e.g. esophageal cancer)

  • Benign esophageal stricture

  • Esophageal web

  • Pharyngeal pouch

  • External esophageal compression (e.g. retrosternal goitre, lymphoma)

  • Esophageal motility disorders (e.g. achalasia, esophageal spasm)

  • Systemic sclerosis

Abdominal Pain (Medical Causes)

• Acute abdominal pain (lasting <24-48 hours):

  • Vaso-occlusive crisis in sickle cell patient

  • Acute exacerbations of peptic ulcer disease or gastritis

  • Cholelithiasis

  • Nephrolithiasis

  • DKA

  • Addisonian crisis

  • Hepatitis

  • Pneumonia

  • Cholangitis/Cholecystitis

  • Acute pancreatitis

  • Pyelonephritis

  • Acute intermittent porphyria

• Chronic abdominal pain (lasting >3 months):

  • GERD

  • Chronic pancreatitis

  • Peptic ulcer disease/gastritis

  • APCKD

  • Diverticulitis

  • IBD

  • IBS

  • Chronic mesenteric ischemia

Dyspepsia

• Possible causes include:

  • Functional dyspepsia

  • Esophagitis

  • GERD

  • Peptic ulcer disease

  • Gastritis/Duodenitis

  • Gastroparesis

  • Drugs (e.g., metformin, steroids, iron, antibiotics, NSAIDs)

  • Biliary tract disease

  • IBS

  • IBD

  • Metabolic disturbances (e.g., hyper/hypothyroidism, diabetes mellitus, adrenal insufficiency, hyperparathyroidism)

  • Malignancies (e.g., esophageal, gastric, duodenal, pancreatic, liver diseases)

  • Infiltrative diseases (e.g., sarcoidosis)

Nausea and Vomiting

• Acute (<48 hours):

  • GIT: food poisoning, bacterial gastroenteritis (e.g. Salmonella, E. coli), viral gastroenteritis, IBD

  • Non-GIT infections (e.g., UTIs, respiratory infections, meningitis)

  • Medications (e.g., chemotherapy, antibiotics, opioids)

  • Metabolic: diabetic ketoacidosis, electrolyte imbalances, kidney failure

  • Others: kidney stones, gallstones, migraines, anxiety, stress, etc.

• Chronic (lasting 4-6 weeks):

  • Gastrointestinal: gastroparesis, functional dyspepsia, IBS, IBD, chronic pancreatitis

  • Neurological: migraines, vestibular disorders (vertigo), neurodegenerative diseases (Parkinson’s disease)

  • Metabolic: diabetes mellitus, thyroid disorders, electrolyte imbalances

  • Medication-Induced: opioids, chemotherapy, antibiotics

  • Others: anxiety disorders, depression, eating disorders, menstrual-related nausea, pregnancy-related, food intolerances, etc.

Hematemesis/Melena

• Possible causes include:

  • Oesophagitis

  • Gastritis

  • Gastric or duodenal ulcers

  • Gastroesophageal varices

  • Upper gastrointestinal malignancies

  • Mallory Weiss tear

  • Drugs (e.g., anticoagulant use)

  • Rarer causes (e.g., Boerhaave's syndrome, AV malformation)

Jaundice

• Classified into types:

  • Pre-hepatic (e.g., hemolysis)

  • Hepatocellular (e.g., hepatitis - alcoholic, viral, drug-induced, autoimmune; hepatoma, metastatic liver disease, Wilson's disease, hemochromatosis, hepatic congestion due to bvf/rvf)

  • Post-hepatic (e.g., obstructive jaundice due to pancreatic cancer, gallstones, primary biliary cirrhosis, primary sclerosing cholangitis)

Change in Bowel Habits

• Causes include:

  • Colorectal cancer

  • IBD

  • IBS

  • Dysentery

  • Gastroenteritis

  • Diverticular disease

  • Malabsorption

  • Diabetic autonomic neuropathy

  • Metabolic disturbances (e.g., thyroid hormone and calcium abnormalities)

  • Factors likely to cause constipation (e.g., diet, water intake, lack of mobility, drugs such as opioids)

Diarrhea

• Acute:

  • Sudden onset of frequent loose or watery stools lasting less than two weeks.

  • Caused by factors such as infections (viral, bacterial, parasitic), food intolerances, medications, and other underlying health conditions.

• Chronic:

  • Loose, watery stools lasting more than four weeks.

  • Caused by factors such as chronic infections, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), food intolerances, medications, malabsorption syndromes, pancreatic disorders, endocrine disorders, and neurological issues.

Constipation

• Causes include:

  • Dietary factors (low fiber, high fat, or lacking fluids)

  • Lack of physical activity

  • Medications (e.g., opioids, antidepressants, some antacids)

  • Medical conditions (e.g., diabetes, hypothyroidism, IBS)

  • Changes in routine (traveling, changes in daily routine, ignoring urges)

  • Age (slower metabolism, weaker muscles in digestive tract)

  • Psychological factors (stress, anxiety, depression)

  • Neurological disorders (e.g., Parkinson’s disease, multiple sclerosis)

  • Overuse of laxatives (can weaken bowel muscles)

Hematochezia

• Potential causes include:

  • Hemorrhoids

  • Colorectal cancer

  • Gastroenteritis/Dysentery

  • Colitis

  • IBD

  • Diverticular disease

  • Anticoagulant use

  • Angiodysplasia

Genitourinary Symptoms

Hematuria

• Potential causes include:

  • Genitourinary malignancy

  • Renal calculi

  • UTI/prostatitis

  • Glomerulonephritis

  • Polycystic kidney disease

  • Sickle cell disease

  • Hemophilia

  • Anticoagulant use

Polyuria

• Potential causes include:

  • UTI

  • Diabetes mellitus

  • Diabetes insipidus

  • Hyperactive bladder

  • Iatrogenic (e.g., diuretics)

  • Psychogenic polydipsia

  • BPH

Dysuria

• Potential causes include:

  • UTI

  • Pyelonephritis

  • STIs

  • Renal calculi

Flank Pain

• Potential causes include:

  • Nephrolithiasis

  • Pyelonephritis

  • Herpes zoster

  • Papillary necrosis

  • Renal abscess

  • Renal infarct (cardioembolic)

  • Renal vein thrombosis

  • APCKD

  • AAA

  • Retroperitoneal conditions (hemorrhage, fibrosis, malignancy)

  • Pulmonary embolism

  • Pneumonia (lower lobe)

  • Pleural effusion/empyema

  • Subphrenic abscess

  • Biliary tract disease

  • Diverticulitis

  • Bacterial endocarditis with splenic infarct

  • Renal tuberculosis

Erectile Dysfunction

• Potential causes include:

  • Psychogenic factors

  • Vascular issues

  • Drug-induced factors

  • Diabetes mellitus

  • Hormonal (thyroid, pituitary, gonadal)

  • Neurogenic causes

  • Others (e.g., liver disease, sickle cell disease, renal disease, urologic issues)

Neurological Symptoms

Headache

• Types include:

  • First headache potential causes:

  • Meningitis

  • Extradural hemorrhages

  • Subdural hemorrhages

  • Subarachnoid hemorrhages

  • Raised intracranial pressure

  • Hypertensive encephalopathy

  • Brain tumors

  • Brain abscess

  • AVM

  • Temporal arteritis

  • Acute sinusitis

  • Others (e.g., Angle closure glaucoma, medications, trigeminal neuralgia)

  • Recurrent headache types:

  • Migraine

  • Cluster headache

  • Tension headache

Muscle Weakness

• Possible causes include:

  • Stroke/stroke mimics

  • Polymyositis/Dermatomyositis

  • Myasthenia gravis/Lambert Eaton myasthenic syndrome

  • Peripheral neuropathy

  • Radiculopathy/plexopathy

  • Cervical spondylosis (upper limb LMN signs, lower limb UMN signs)

  • Multiple sclerosis

  • Potts disease/transverse myelopathy

  • Tumor or abscess in spine

  • Motor neuron disease

  • Todd's paralysis

Memory Loss

• Possible causes include:

  • Alzheimer disease

  • Vascular dementia

  • Mild cognitive impairment

  • Parkinson disease

  • Diffuse Lewy body disease

  • Frontotemporal dementia

  • Chronic subdural hematoma

  • AIDS dementia complex

  • Late neurosyphilis

  • Systemic autoimmune disorders (e.g., SLE, sarcoidosis, Behçet's)

  • Brain tumor

  • Korsakoff syndrome

  • Vitamin B12 deficiency

  • Normal pressure hydrocephalus

  • Hyperthyroidism

  • Hypothyroidism

  • Pseudodementia

  • Whipple disease

Gait Abnormalities

• Possible causes include:

  • Spinal cord disorders

  • Cerebellar ataxia

  • Stroke/stroke mimics

  • Normal pressure hydrocephalus

  • Aortic dissection causing cord ischemia

  • Peripheral neuropathy

  • Sensory ataxia

Tremors

• Possible causes include:

  • Essential tremor

  • Parkinson's disease/Parkinsonism

  • Wilson's disease

  • Cerebellar dysfunction

  • Stress and anxiety

  • Alcohol use disorders

  • Hypoglycemia

  • Hyperthyroidism

  • Medications

  • Multiple sclerosis

Syncope

• Medical term refers to fainting due to reduced blood flow to the brain.

• People usually recover quickly, often within seconds to minutes.

• Possible causes include:

  • Vasovagal syncope

  • Situational syncope

  • Carotid sinus syncope

  • Orthostatic hypotension (e.g., adrenal insufficiency, drugs)

  • Neurologic disorders (e.g., vertebrobasilar TIA, basilar migraine, subclavian steal syndrome)

  • Drugs

  • Arrhythmias

  • Cardiac diseases (e.g., aortic stenosis, HOCM, pulmonary embolism, myocardial infarction, atrial myxoma, pulmonary hypertension, aortic dissection, pericardial tamponade)

  • Hypoglycemia

  • Dehydration

  • Sudden changes in posture

Collapse

• Refers to sudden loss of muscle strength or consciousness, can be due to syncope or other causes like seizures, strokes, or cardiac arrest.

• Causes include:

  • Vasovagal syncope

  • Cardiogenic syncope (e.g., aortic stenosis, ACS)

  • Stokes Adams attack

  • Seizure

  • Situational syncope (e.g., micturition)

  • Carotid sinus syncope

  • Postural hypotension (e.g., from drugs like ACE inhibitors)

Seizures

• Possible causes include:

  • Epilepsy

  • Stroke/SAH

  • Brain tumors (primary or metastatic)

  • Infections (e.g., malaria, meningitis, encephalitis)

  • Metabolic disorders (e.g., imbalances in electrolytes or blood sugars)

  • End organ failures

  • Hypertensive encephalopathy

  • Medications or withdrawal

  • Alcohol withdrawal

  • Autoimmune disorders (e.g., autoimmune encephalitis, SLE)

  • Head injuries

  • Genetic factors

  • Unknown causes

Dizziness

• Describes a variety of unsteady feelings (faint, unsteady, or lightheadedness).

• Possible causes include:

  • Anemia

  • Hypoglycemia

  • Hypotension

  • Migraine

  • Dehydration

  • Anxiety and stress

  • Infections (e.g., sinusitis, flu, Ramsay Hunt syndrome, Meningoencephalitis)

  • Neurological disorders (e.g., Parkinson's disease, multiple sclerosis)

  • Drug-related causes (e.g., antihypertensives, antidepressants, sedatives)

  • Cardiovascular issues (e.g., arrhythmias, heart attack)

Vertigo

• Characterized by the sensation of spinning, associated with vestibular system issues.

• Often accompanied by nausea and balance problems.

• Common causes include:

  • Benign paroxysmal positional vertigo (BPPV)

  • Meniere's disease

  • Vestibular neuritis

  • Labyrinthitis

  • Migraines

  • Stroke affecting posterior circulation

  • Acoustic neuroma

  • Ototoxic medications

  • Head or neck injuries

Diplopia

• Potential causes include:

  • Ocular myopathy (e.g., Graves ophthalmopathy)

  • Neuromuscular junction disease (e.g., myasthenia gravis)

  • Cranial nerve abnormalities (e.g., DM, brain tumor, cerebral aneurysm, infections, inflammation)

  • Brainstem disorders (e.g., stroke, tumor, demyelination)

  • Increased ICP

  • Cavernous sinus mass

Rheumatological & Dermatological Symptoms

Back Pain

• Mechanical causes include:

  • Disc prolapse

  • Radiculopathy (sciatica)

  • Cauda equina syndrome

  • Malignancy

  • Osteoporosis (crush fracture)

  • Infection (discitis, TB)

  • Inflammatory back pain (HLA-B27 associated)

• Non-spinal causes include:

  • Dissecting aneurysm

  • Fibromyalgia

  • Pancreatitis

  • Renal calculi

Joint Pain

• Inflammatory conditions may include:

  • Rheumatoid arthritis

  • HLA-B27 associated conditions

  • SLE

  • Infections (e.g., septic arthritis, gonococcal arthritis)

• Non-inflammatory conditions may include:

  • Osteoarthritis

  • Gout

  • Pseudogout

  • Fibromyalgia

  • Vaso-occlusive crisis in sickle cell anemia

Rash

• Can be caused by:

  • Infections (bacterial, viral, fungal infections - e.g., HIV infection, Herpes zoster, secondary syphilis)

  • Autoimmune disorders (e.g., psoriasis, dermatomyositis)

  • Allergens causing adverse skin reactions

  • Irritants causing contact dermatitis

  • Medications causing adverse skin reactions

  • Diabetes mellitus, thyroid disorders, liver diseases that may manifest with skin rashes

  • Erythema nodosum

  • Sarcoidosis

  • Mitral stenosis