original_id int64 1 915 | dataset stringclasses 1
value | ground_truth_text stringlengths 4 190 | question_text stringlengths 481 2.76k | golden_evidence listlengths 1 13 |
|---|---|---|---|---|
1 | DiagnosisArena | Cutaneous meningeal heterotopia (CMH) | === CASE INFORMATION ===
A woman in her early 70s presented with a solitary, asymptomatic lump on her scalp. The lesion was present since birth but showed some growth following minor local trauma a couple of months prior to evaluation. No local inflammation, purulent discharge, or systemic symptoms were reported. Medic... | [
{
"original_text": "Cells without discernible cell membranes, forming whorls and strands around collagen bundles",
"type": "Inclusion"
},
{
"original_text": "Focally positive: progesterone receptor",
"type": "Inclusion"
},
{
"original_text": "Demonstrated a nonenhancing tumor with sharp ... |
2 | DiagnosisArena | Scrotal ulceration secondary to induction chemotherapy with ATRA | === CASE INFORMATION ===
A previously healthy man in his 30s presented with spontaneous bruising, epistaxis, and haematuria. After starting treatment, the patient developed pyrexia after 12 days. Two days later, he developed tender black spots on the scrotum that progressed to painful ulcers over 8 days. As scrotal ulc... | [
{
"original_text": "spontaneous bruising, epistaxis, and haematuria.",
"type": "Inclusion"
},
{
"original_text": "After starting treatment, the patient developed pyrexia after 12 days.",
"type": "Inclusion"
},
{
"original_text": "Two days later, he developed tender black spots on the scr... |
3 | DiagnosisArena | Familial cerebral cavernous malformations | === CASE INFORMATION ===
A female patient in her early 50s presented with multiple (approximately 10) bluish, partially keratotic papules and nodules on the lower legs. The lesions had been growing very slowly in number and size since age 24 and had been bleeding occasionally after trauma. The patient used a wheelchair... | [
{
"original_text": "Result: Detection of a heterozygous pathogenic KRIT1 variant.",
"type": "Inclusion"
},
{
"original_text": "At age 4, she had recurrent seizures.",
"type": "Inclusion"
},
{
"original_text": "The patient used a wheelchair due to right-sided hemiparesis and hemianopsia c... |
4 | DiagnosisArena | Microvenular hemangioma (MVH) | === CASE INFORMATION ===
A female patient in her late 20s presented with a 2-year history of multiple, slowly growing, infiltrated erythematous-violaceous patches and plaques, with occasional slight pain extending from her left upper arm to the left side of her chest. No triggers such as local infection, insect bite, o... | [
{
"original_text": "Thin-walled, irregularly branched blood vessels dispersed between thickened collagen bundles",
"type": "Differentiation"
},
{
"original_text": "Endothelial cells were plump but displayed no significant cytologic atypia",
"type": "Differentiation"
},
{
"original_text":... |
5 | DiagnosisArena | Left maxillary giant cell reparative granuloma (GCRG) | === CASE INFORMATION ===
A teenage girl presented with several months of sinus pressure and facial swelling, and several weeks of external deviation of her nasal septum. No significant past medical history was mentioned.
=== PHYSICAL EXAMINATION ===
On examination, a left nasal mass was noted. Mild left-sided proptosi... | [
{
"original_text": "Left maxillary alveolar ridge and several molar roots involved.",
"type": "Inclusion"
},
{
"original_text": "Bony changes showed remodeling and thinning.",
"type": "Inclusion"
},
{
"original_text": "several months of sinus pressure and facial swelling",
"type": "I... |
6 | DiagnosisArena | Metastatic Crohn disease | === CASE INFORMATION ===
A 12-year-old female presented with asymptomatic vulvar edema of 1 month's duration that was previously treated with topical antifungals and corticosteroids with no improvement. She did not report recent travel or sexual relationships. Medical history included growth delay, several months of co... | [
{
"original_text": "Intact epidermis with nodular dermatitis composed of non-necrotizing granulomas in superficial and deep dermis",
"type": "Inclusion"
},
{
"original_text": "Examination revealed swelling, erythema, and palpable induration on the labia minora and majora of the vulva.",
"type": ... |
7 | DiagnosisArena | Segmental stiff skin syndrome (SSS) | === CASE INFORMATION ===
An 11-year-old boy presented with progressive unilateral skin hardening on his right thigh and buttock for 7 years. Recently, the motion of his right limb joint was slightly limited. He was born to healthy parents and did not have any medical disease.
=== PHYSICAL EXAMINATION ===
There was an ... | [
{
"original_text": "Alcian blue staining: Negative",
"type": "Differentiation"
},
{
"original_text": "but no evidence of inflammation.",
"type": "Differentiation"
},
{
"original_text": "Normal epidermis",
"type": "Differentiation"
},
{
"original_text": "An 11-year-old boy pre... |
8 | DiagnosisArena | Primary cutaneous trichosporonosis caused by Trichosporon mycotoxinivorans | === CASE INFORMATION ===
A woman in her 20s presented with a large erythematous indurated plaque involving the face and neck that had been first noted at age 2 years. The plaque progressively increased in size, and similar plaques developed over the back, right dorsal surface of the hand, suprapubic area, and right thi... | [
{
"original_text": "Direct potassium hydroxide preparation: Multiple budding yeast cells and arthrospores observed",
"type": "Differentiation"
},
{
"original_text": "Skin biopsy: Granulomatous infiltrate with giant cells, lymphocytes, histiocytes, neutrophils, and eosinophils. Hyaline hyphae branchi... |
9 | DiagnosisArena | Aquagenic syringeal acrokeratoderma (ASA) | === CASE INFORMATION ===
A man in his 20s presented with thickening and swelling of hands after immersion in water, accompanied by burning pruritus for 3 years. The lesions occurred as symmetrical white and transparent papules, white keratosis, excessive wrinkling on the dorsum of hands after water immersion and worsen... | [
{
"original_text": "After immersing both hands in water for 10 mins, there were symmetrical white papules, white hyperkeratosis spots, and excessive wrinkling on the thenar eminence, wrist flexure of both hands, and dorsum of fingers and hands.",
"type": "Inclusion"
},
{
"original_text": "thickening... |
10 | DiagnosisArena | Facial discoid dermatosis (FDD) | === CASE INFORMATION ===
A woman in her early 40s presented with a 10-year history of facial rash. She denied itch, pain, or other symptoms, but reported greatly affected quality of life.
=== PHYSICAL EXAMINATION ===
Multiple well-demarcated, orangish-pink, flat-topped papules and plaques with fine scale that involved... | [
{
"original_text": "No involvement of the trunk, extremities, or ears was identified.",
"type": "Differentiation"
},
{
"original_text": "Multiple well-demarcated, orangish-pink, flat-topped papules and plaques with fine scale",
"type": "Differentiation"
},
{
"original_text": "Mild superf... |
11 | DiagnosisArena | Acute dacryocystitis with secondary optic nerve injury | === CASE INFORMATION ===
A 59-year-old woman presented with 2 days of left orbital pain. Medical history was significant for hypertension controlled with lisinopril and several months of epiphora without prior dacryocystitis.
=== PHYSICAL EXAMINATION ===
Examination revealed:- Visual acuity: 20/25 OD and 20/400 OS- Ed... | [
{
"original_text": "several months of epiphora",
"type": "Inclusion"
},
{
"original_text": "opacification of both nasolacrimal ducts",
"type": "Inclusion"
},
{
"original_text": "Left-sided lacrimal sac abscess",
"type": "Inclusion"
},
{
"original_text": "postseptal fat strand... |
12 | DiagnosisArena | Kaposiform hemangioendothelioma (KHE) of the internal auditory canal | === CASE INFORMATION ===
A 4-week-old male presented with left facial asymmetry while crying noted by the mother. The patient had previously passed infant hearing screening.
=== PHYSICAL EXAMINATION ===
Left facial asymmetry observed during crying.
=== DIAGNOSTIC TESTS ===
- Imaging Studies: * MRI findings: Enhanc... | [
{
"original_text": "Biphasic lesion composed of vascular nodules among spindle cells",
"type": "Inclusion"
},
{
"original_text": "Glomeruloid-like architecture of vascular epithelial nodules",
"type": "Inclusion"
},
{
"original_text": "CD34 and CD31: Positive for endothelial cells",
... |
13 | DiagnosisArena | Gadolinium-associated plaques (GAP) | === CASE INFORMATION ===
A white woman in her 60s with end-stage renal disease presented with a several-month history of nontender, reddish-brown, thickened, dermal plaques on her thighs, left hip, and right forearm. She had received numerous medical scans throughout her lifetime, but the cumulative dose and type of co... | [
{
"original_text": "Laser ablation inductively coupled plasma mass spectrometry confirmed dermal deposition of gadolinium localized to sclerotic bodies",
"type": "Inclusion"
},
{
"original_text": "end-stage renal disease",
"type": "Inclusion"
},
{
"original_text": "nontender, reddish-bro... |
14 | DiagnosisArena | Iatrogenic hypercalcemia | === CASE INFORMATION ===
A woman in her late teens with a 1-year history of viral cardiomyopathy presented with decompensated heart failure. Over 5 days of initial treatment, she improved clinically and passed 7 liters of urine. On hospital days 6 and 7, she became increasingly somnolent with urinary incontinence, cons... | [
{
"original_text": "Whole blood calcium: >26 mg/dL",
"type": "Inclusion"
},
{
"original_text": "Ionized calcium: 11.16 mg/dL",
"type": "Inclusion"
},
{
"original_text": "Intact parathyroid hormone: 11 pg/mL (low; normal 16-60 pg/mL)",
"type": "Differentiation"
},
{
"original_... |
15 | DiagnosisArena | Primary oral histoplasmosis | === CASE INFORMATION ===
A 40-year-old man from eastern India presented with a nonhealing ulcer on the tongue present for the last 4 months. The lesion started as a small painless mass on the right lateral aspect of the tongue, which gradually grew and subsequently ulcerated. It caused mild difficulty in eating. No his... | [
{
"original_text": "Many histiocytes and giant cells contained intracellular yeasts with a surrounding halo",
"type": "Inclusion"
},
{
"original_text": "Special stains (Grocott-Gomori methenamine-silver nitrate and periodic acid–Schiff) highlighted fungal forms",
"type": "Inclusion"
},
{
... |
16 | DiagnosisArena | Giant macroprolactinoma | === CASE INFORMATION ===
An adult patient with morbid obesity and otherwise no significant medical history presented with progressive headache, double vision, and blurry vision over the past year, which acutely worsened over the past 2 months. Concurrent decreased libido and erectile dysfunction were reported.
=== PHY... | [
{
"original_text": "Mass measuring >5cm centered in and expanding the sella turcica",
"type": "Inclusion"
},
{
"original_text": "Prolactin: 8094 ng/mL (reference range: 4-15 ng/mL)",
"type": "Inclusion"
},
{
"original_text": "Prolactin: 8094 ng/mL (reference range: 4-15 ng/mL)",
"typ... |
17 | DiagnosisArena | Nodular amyloid | === CASE INFORMATION ===
A man in his 60s with diabetes presented with an asymptomatic shiny indurated plaque on the right plantar foot, which had been slowly growing for the past year. Medical history included long-standing, intermittent dyspnea on exertion, but no baseline shortness of breath, orthopnea, or bilateral... | [
{
"original_text": "Congo red stain: Positive",
"type": "Inclusion"
},
{
"original_text": "Large amounts of globular eosinophilic material in the dermis",
"type": "Inclusion"
},
{
"original_text": "scattered plasma cells",
"type": "Inclusion"
},
{
"original_text": "A 4.5 cm w... |
18 | DiagnosisArena | ERK inhibitor-associated retinopathy (ERKAR) | === CASE INFORMATION ===
A 64-year-old woman presented to the emergency department with bilateral progressive blurred vision. Medical history includes lung adenocarcinoma managed with partial lobectomy 4 years prior, with local recurrence treated with 6 cycles of carboplatin, pemetrexed, and pembrolizumab. A second rec... | [
{
"original_text": "Symptoms started 1 day after starting ulixertinib",
"type": "Inclusion"
},
{
"original_text": "multifocal, yellow, subretinal deposits in the posterior pole that were hyperautofluorescent on fundus autofluorescence",
"type": "Inclusion"
},
{
"original_text": "Shows cy... |
19 | DiagnosisArena | Follicular thyroid carcinoma with manubrial invasion | === CASE INFORMATION ===
A man in his 70s presented with swelling of the manubrium 12 years after resection of a large left substernal thyroid lobe through a midline sternotomy approach. The swelling was slightly tender and had increased in size markedly over the month prior to presentation. Medical history includes pr... | [
{
"original_text": "Revealed follicular thyroid cells in the goiter and the manubrial lesion.",
"type": "Inclusion"
},
{
"original_text": "Hematoxylin-eosin stained specimens showing thyroid follicles infiltrating adjacent to bone trabeculae (at ×20 and ×10 magnification).",
"type": "Inclusion"
... |
20 | DiagnosisArena | Drug-induced ANCA vasculitis secondary to hydralazine | === CASE INFORMATION ===
A woman in her 70s presented with a week of painless, rapidly progressive, edematous, necrotic papules and plaques on the extremities, buttocks, and face with sharp demarcation at the nasolabial folds and extension into the oral mucosa. Notable symptoms included 4 months of extreme fatigue, 20.... | [
{
"original_text": "hydralazine hydrochloride",
"type": "Inclusion"
},
{
"original_text": "antineutrophil cytoplasmic antibody with perinuclear staining (1:1280)",
"type": "Inclusion"
},
{
"original_text": "myeloperoxidase antibody level of 103 AU/mL",
"type": "Inclusion"
},
{
... |
21 | DiagnosisArena | Saturday night retinopathy with orbital compression syndrome | === CASE INFORMATION ===
An obese man in his mid-30s with no prior systemic or ocular disorders presented to a local emergency department after waking with vision loss in his right eye. The night prior, he had been drinking alcohol heavily and took 2 buprenorphine hydrochloride/naloxone hydrochloride pills. He denied a... | [
{
"original_text": "Visual acuity: No light perception in right eye (OD) and 20/20 in left eye (OS).",
"type": "Inclusion"
},
{
"original_text": "Right pupil was mid-dilated with a relative afferent pupillary defect.",
"type": "Inclusion"
},
{
"original_text": "Intraocular pressure was 3... |
22 | DiagnosisArena | Antimelanoma differentiation associated gene 5 clinically amyopathic dermatomyositis | === CASE INFORMATION ===
A 42-year-old African American male presented with a 7-month history of fatigue, exertional dyspnea, arthralgias, hand swelling, tender ulcerations, hair loss, and a 50-pound weight loss. He had been hospitalized 6 months prior for hypoxia. He had been treated with prednisone previously.
=== P... | [
{
"original_text": "Oxford Scale muscle strength was 5 of 5 throughout.",
"type": "Inclusion"
},
{
"original_text": "Creatine kinase: 32 U/L (depressed)",
"type": "Inclusion"
},
{
"original_text": "Aldolase: 4.5 U/L (normal)",
"type": "Inclusion"
},
{
"original_text": "Follow... |
23 | DiagnosisArena | Postinfectious altered bowel habits with C. difficile colonization | === CASE INFORMATION ===
A 28-year-old man with a history of recent azithromycin treatment for pneumonia presented with abdominal pain and diarrhea (10-12 Bristol type 7 stools per day). After initial treatment, his bowel movements returned to baseline of 2-3 Bristol type 4 stools per day. Six weeks later, he presented... | [
{
"original_text": "abdominal discomfort for 3 weeks that was relieved by bowel movements",
"type": "Inclusion"
},
{
"original_text": "associated with increased stool frequency (4-5 Bristol type 4 stools per day)",
"type": "Differentiation"
},
{
"original_text": "Positive repeat stool te... |
24 | DiagnosisArena | Cutaneous silica granuloma | === CASE INFORMATION ===
A miner in his early 40s presented with a 6-month history of asymptomatic, erythematous nodules on his face, chin, anterior portion of neck, and anterior thorax. Approximately 15 years earlier, he had sustained injuries from an accidental land mine explosion that had lacerated his face, neck, a... | [
{
"original_text": "Under polarization microscopy, particles were birefringent.",
"type": "Inclusion"
},
{
"original_text": "Energy-dispersive radiographic spectroscopy: Particles contained silicon",
"type": "Inclusion"
},
{
"original_text": "Multiple nonfusing, noncaseating granulomas c... |
25 | DiagnosisArena | Drug-induced bilateral choroidal detachment | === CASE INFORMATION ===
A 73-year-old man presented with bilateral foggy vision and visual field constrictions during the second half of his first infusion treatment, scheduled as fourth-line monotherapy. Symptoms of bilateral field constrictions progressed during the following hours. The patient was diagnosed in 2013... | [
{
"original_text": "Ultrawide-field ophthalmoscopic examination revealed dome-shaped bilateral choroidal detachments with the characteristic imprint of choroidal vasculature.",
"type": "Inclusion"
},
{
"original_text": "B-scan ultrasonography: showed bilateral detached choroid stretching to the ora ... |
26 | DiagnosisArena | Chemical burns of the pharynx and esophagus due to e-cigarette injury | === CASE INFORMATION ===
A man presented to the emergency department (ED) on transfer from an outside hospital after falling with an e-cigarette in his mouth several hours earlier. The patient did not remember the exact cause of the fall, but believed he may have lost consciousness.
=== PHYSICAL EXAMINATION ===
Physic... | [
{
"original_text": "after falling with an e-cigarette in his mouth several hours earlier.",
"type": "Inclusion"
},
{
"original_text": "Physical examination in the ED showed diffuse supraglottic edema that was most severe in the epiglottis, arytenoids, aryepiglottic folds, and obstructed a view of th... |
27 | DiagnosisArena | Histiocytoid Sweet syndrome | === CASE INFORMATION ===
A man in his late 60s presented with a 10-day history of fever up to 38.5°C and tender lesions on the neck and trunk. Past medical history included a 10-year history of IgG-κ multiple myeloma, with recent first cycle of chemotherapy (ixazomib, lenalidomide, and dexamethasone) in the previous mo... | [
{
"original_text": "fever up to 38.5°C",
"type": "Inclusion"
},
{
"original_text": "tender lesions on the neck and trunk",
"type": "Inclusion"
},
{
"original_text": "outer erythematous and edematous ring",
"type": "Inclusion"
},
{
"original_text": "Inflammatory infiltrate of ... |
28 | DiagnosisArena | Bayés syndrome (Advanced interatrial block with paroxysmal atrial arrhythmias) | === CASE INFORMATION ===
A patient in their 70s presented with worsening shortness of breath, chest tightness, and episodes of palpitations. Medical history was remarkable for hypertension and kidney insufficiency.
=== PHYSICAL EXAMINATION ===
Initial evaluation revealed:- Heart rate: 53 beats/min- Blood pressure: 221... | [
{
"original_text": "prolonged P-wave duration (180 milliseconds)",
"type": "Inclusion"
},
{
"original_text": "biphasic P wave morphology in leads II, III, and aVF",
"type": "Inclusion"
},
{
"original_text": "Shows atrial flutter",
"type": "Inclusion"
},
{
"original_text": "Le... |
29 | DiagnosisArena | IgG4-related rhinosinusitis with concurrent Streptococcus constellatus bacterial rhinosinusitis | === CASE INFORMATION ===
A man in his 70s with no history of chronic or allergic rhinosinusitis presented to the emergency department with a headache for 2 weeks and vision loss in the right eye for 2 days. Three weeks prior, he had rhinorrhea and was diagnosed with COVID-19. He recovered from COVID-19 but developed a ... | [
{
"original_text": "Dense infiltrate of IgG-containing plasma cells, with most being IgG4 positive",
"type": "Inclusion"
},
{
"original_text": "'Serum IgG4': '277 mg/dL (normal, <123 mg/dL)'",
"type": "Inclusion"
},
{
"original_text": "'Sinus Cultures': 'Positive for Streptococcus conste... |
30 | DiagnosisArena | Nevocytic ciliary body nevus with extrascleral extension | === CASE INFORMATION ===
A woman in her 40s presented with a well-circumscribed, pigmented, episcleral lesion in her right eye. Best-corrected visual acuity was 20/16 OD.
=== PHYSICAL EXAMINATION ===
Well-circumscribed, pigmented, episcleral lesion observed in the right eye.
=== DIAGNOSTIC TESTS ===
- Ultrasound biom... | [
{
"original_text": "Revealed adjacent ciliary body tumor with a ciliary artery channel connecting the intrascleral and extrascleral tumor portions.",
"type": "Inclusion"
},
{
"original_text": "Ultrasound biomicroscopy: Showed extension of a dome-shaped primary ciliary body tumor.",
"type": "Incl... |
31 | DiagnosisArena | Extensive dermatophytosis due to autosomal recessive CARD9 deficiency (homozygous Q289X mutation) | === CASE INFORMATION ===
A male patient in the fourth decade of life, born to an Egyptian family and living in France. From age 13, he presented with pruritic dermatosis, beginning with erythematous lesions on hands and lower limbs. The condition progressed over time, and 5 years ago, he developed disseminated squamous... | [
{
"original_text": "Skin cultures: yielded Trichophyton rubrum",
"type": "Inclusion"
},
{
"original_text": "Skin scrapings (multiple sites - palms, back, groin, foot sole, and toes): presence of hyphae",
"type": "Inclusion"
},
{
"original_text": "presence of hyphae in the epidermis (peri... |
32 | DiagnosisArena | Extrafacial granuloma faciale | === CASE INFORMATION ===
A man in his 30s presented with a 3-month history of gradual growth of a pruriginous, reddish nodule on the left ear. He had no relevant medical history.
=== PHYSICAL EXAMINATION ===
A reddish, smooth, superficial nodule with small dimples and a soft consistency that measured approximately 1.5... | [
{
"original_text": "characteristic sparing of a superficial dermal grenz zone",
"type": "Inclusion"
},
{
"original_text": "small-vessel vasculitis",
"type": "Inclusion"
},
{
"original_text": "mixed leukocytic infiltrate with eosinophils, lymphocytes, and neutrophils",
"type": "Differ... |
33 | DiagnosisArena | ST-segment elevation due to myocardial metastasis from squamous cell carcinoma of the lung | === CASE INFORMATION ===
A man in his 70s presented to the emergency department with progressive dyspnea on exertion. His medical history includes multiple prior cardiac events and lung cancer with metastatic disease to the brain and myocardium. Ten months prior, he had received 2 drug-eluting stents to the right coron... | [
{
"original_text": "lung cancer with metastatic disease to the brain and myocardium.",
"type": "Inclusion"
},
{
"original_text": "Well-circumscribed 2.8 × 2.6-cm mass located in the left ventricular mid-apical anteroseptum",
"type": "Inclusion"
},
{
"original_text": "4.0-mm ST elevation ... |
34 | DiagnosisArena | Toxic encephalopathy due to systemic absorption of topical ketamine-amitriptyline-lidocaine compound | === CASE INFORMATION ===
A highly functioning man in his 80s with a history of Parkinson disease and atopic dermatitis presented to the emergency department. He had severe intractable pruritus that was resistant to multiple standard treatments. Four days prior, he was prescribed mycophenolate mofetil (MMF) 500mg twice ... | [
{
"original_text": "Ketamine (2360 ng/mL; normal level: 0 ng/mL) and metabolites including norketamine",
"type": "Inclusion"
},
{
"original_text": "he gradually increased coverage to most of his upper body the evening before presentation.",
"type": "Inclusion"
},
{
"original_text": "a to... |
35 | DiagnosisArena | Cardiac Memory (T-wave memory) | === CASE INFORMATION ===
A man in his 80s presented for his 1-month follow-up after bioprosthetic aortic valve placement. Medical history includes paroxysmal atrial fibrillation, first degree atrioventricular block, and sick sinus syndrome with a dual-chamber permanent pacemaker placed a year prior. The pacemaker's low... | [
{
"original_text": "Baseline ECG (2 weeks prior): Shows underlying atrial fibrillation with ventricular pacing at 80 bpm. QRS complexes were 198 milliseconds wide and negatively directed with upright T waves in precordial and inferior leads.",
"type": "Inclusion"
},
{
"original_text": "The pacemaker... |
36 | DiagnosisArena | Primary cutaneous cryptococcosis (PCC) | === CASE INFORMATION ===
A 62-year-old woman with multiple sclerosis treated with fingolimod for 3 years presented with a tender nodule on her forehead, which had gradually grown over 3 weeks. She reported bumping her forehead on an air-conditioning unit several months prior. She denied fever, neck stiffness, and photo... | [
{
"original_text": "Eroded, crusted papule on the left forehead",
"type": "Inclusion"
},
{
"original_text": "Tissue culture: Grew Cryptococcus neoformans",
"type": "Inclusion"
},
{
"original_text": "Cerebrospinal fluid cryptococcal antigen: Negative",
"type": "Exclusion"
},
{
... |
37 | DiagnosisArena | Cutaneous plasmablastic posttransplantation lymphoproliferative disorder (pPTLD) | === CASE INFORMATION ===
A man in his 50s presented with an abdominal skin eruption of 2 days' duration. His medical history included hepatitis C, cirrhosis, and an orthotopic liver transplant (OLT) 3 years prior that was subsequently treated with tacrolimus, 5 mg, and mycophenolate, 750 mg, twice daily. Approximately ... | [
{
"original_text": "an orthotopic liver transplant (OLT) 3 years prior",
"type": "Inclusion"
},
{
"original_text": "tacrolimus, 5 mg, and mycophenolate, 750 mg, twice daily",
"type": "Inclusion"
},
{
"original_text": "confluent indurated violaceous papules and plaques coalescing into an ... |
38 | DiagnosisArena | Nevus comedonicus | === CASE INFORMATION ===
A teenage girl presented with asymptomatic, punctate, keratotic papules localized to the right palm and right third proximal finger, present since age 2 years. Prior treatments included cryotherapy, pulsed dye laser, and 40% salicylic acid, with partial improvement reported but never complete c... | [
{
"original_text": "Grouped and circumscribed, firm, skin-colored, 1- to 3-mm papules with a central punctate dark core on the right palm and finger.",
"type": "Inclusion"
},
{
"original_text": "Grouped, dome-shaped, skin-colored, punctate papules with central keratotic plugging localized to the rig... |
39 | DiagnosisArena | Metastatic Crohn disease | === CASE INFORMATION ===
A woman in her 50s with a medical history of hypertension and depression presented with a 1.5-year history of painful intertriginous wounds. She had been admitted to the hospital multiple times for cellulitis around the wounds, which responded to intravenous antibiotics. She had received a dive... | [
{
"original_text": "Well-formed, nonnecrotizing granulomas",
"type": "Inclusion"
},
{
"original_text": "Langhans-type multinucleated giant cells",
"type": "Inclusion"
},
{
"original_text": "Linear moist, eroded, exophytic, condyloma-like plaques",
"type": "Inclusion"
},
{
"or... |
40 | DiagnosisArena | Invasive squamous cell carcinoma arising in a seborrheic keratosis of the eyelid | === CASE INFORMATION ===
A man in his mid-80s presented with a 4-year history of a left lower eyelid mass, noted by his wife to have recently grown and acquired a crust.
=== PHYSICAL EXAMINATION ===
On examination, a yellowish-brown, well-circumscribed papule was discovered on the central lower eyelid without margin i... | [
{
"original_text": "Classic-appearing hyperkeratotic lesion with many pseudohorn cysts",
"type": "Inclusion"
},
{
"original_text": "Proliferation of neoplastic squamous cells originated from one lateral end, pushing down into the dermis and involving many hairs",
"type": "Inclusion"
},
{
... |
41 | DiagnosisArena | Position-dependent ventricular tachycardia induced by displaced PICC line | === CASE INFORMATION ===
A patient in their 30s with obesity and a history of alcohol use was found to have recurrent arrhythmia during hospitalization. The patient had a prolonged hospital stay complicated by delirium tremens, intubation, and ventilator-associated pneumonia requiring multiple courses of antibiotics. T... | [
{
"original_text": "Revealed displacement of the PICC tip into the right atrium at the level of the tricuspid valve",
"type": "Inclusion"
},
{
"original_text": "Shows fusion beat (hybrid complex from sinus and ventricular beat)",
"type": "Differentiation"
},
{
"original_text": "The arrhy... |
42 | DiagnosisArena | Pseudoepitheliomatous hyperplasia | === CASE INFORMATION ===
A black woman in her 50s presented with a 3-month history of nontender mildly pruritic verrucous nodules in several areas of a polychromatic tattoo on her right lower leg and foot. The nodules appeared 1-2 months following tattoo placement and were restricted to areas where pink zones were crea... | [
{
"original_text": "Shows hyperplasia of the epidermis and adnexal epithelium with granulomatous inflammation and tattoo pigment within the dermis",
"type": "Inclusion"
},
{
"original_text": "without atypical nesting of keratinocytes or cellular atypia",
"type": "Differentiation"
},
{
"o... |
43 | DiagnosisArena | Left posterior fascicular ventricular tachycardia (LPF-VT) associated with anti-ERBB2 therapy | === CASE INFORMATION ===
A woman in her 20s presented to the emergency department with a 1-day history of palpitations and dyspnea. Her medical history was significant for breast cancer, for which she had received total mastectomy of the right breast, followed by 5 cycles of dual anti-ERBB2 treatments with trastuzumab ... | [
{
"original_text": "atypical right bundle-branch block pattern",
"type": "Inclusion"
},
{
"original_text": "superior left-axis deviation",
"type": "Inclusion"
},
{
"original_text": "QRS duration 132 milliseconds",
"type": "Inclusion"
},
{
"original_text": "positive QRS in aVR... |
44 | DiagnosisArena | Atypical hand-foot-mouth disease | === CASE INFORMATION ===
A man in his 70s with a history of chronic lymphocytic leukemia (CLL) and prescribed cyclosporine, 100 mg twice daily, for pure red cell aplasia. Initial symptoms included rhinorrhea, cough, and low-grade fever 2 weeks prior. After treatment with azithromycin, he developed small, pruritic blist... | [
{
"original_text": "Positive enterovirus PCR from skin lesion and blood sample",
"type": "Inclusion"
},
{
"original_text": "he developed small, pruritic blisters on hands and feet",
"type": "Inclusion"
},
{
"original_text": "Oral cavity showed 1 violaceous macule on right buccal mucosa a... |
45 | DiagnosisArena | Drug-induced dermatomyositis secondary to ipilimumab therapy | === CASE INFORMATION ===
A woman in her 50s with stage IV B-RAF V600E mutant malignant melanoma with metastases of the liver, lungs, and peritoneum (primary site unknown). Within 2 weeks of starting ipilimumab treatment, she developed skin symptoms. After initial improvement and later disease recurrence, she received a... | [
{
"original_text": "Flat-topped pink to erythematous papules over knuckles",
"type": "Inclusion"
},
{
"original_text": "Erythema and edema of upper eyelids",
"type": "Inclusion"
},
{
"original_text": "Diffuse erythema of upper chest and upper back",
"type": "Inclusion"
},
{
"... |
46 | DiagnosisArena | Eosinophilic angiocentric sclerosis related to IgG4 with isolated eyelid involvement | === CASE INFORMATION ===
A 51-year-old woman presented with asymmetrical eyelid tumefactions. Six years earlier, she had episodes of pruriginous inflammatory edema of the eyelid. By the time of admission, the eyelid edema had become permanent and progressively became rock hard to palpation, which severely limited visio... | [
{
"original_text": "Elevated IgG1, IgG2, and IgG4 levels (IgG4: 202.53 mg/dL)",
"type": "Inclusion"
},
{
"original_text": "Most plasma cells expressed IgG, with an IgG4/IgG ratio greater than 60%",
"type": "Inclusion"
},
{
"original_text": "116 IgG4-positive plasma cells counted per high... |
47 | DiagnosisArena | Isorhythmic atrioventricular dissociation (AVD) with atrial ectopic rhythm and junctional rhythm | === CASE INFORMATION ===
A man in his 60s presented to the emergency department with chest pain. He had a history of hypertension but no other cardiac history. His pain was described as a dull ache localized to his epigastrium; it had been constant for 4 hours, did not radiate, and was not exacerbated by exertion.
===... | [
{
"original_text": "Image Title: Figure 2. Lead II Showing Atrioventricular Dissociation",
"type": "Inclusion"
},
{
"original_text": "Image Title: Figure 1. Initial Electrocardiogram Showing Atrial Ectopic and Junctional Rhythms and P-Wave Mimicry",
"type": "Inclusion"
},
{
"original_tex... |
48 | DiagnosisArena | Borderline-borderline leprosy | === CASE INFORMATION ===
A woman in her 50s with a 2-year history of disseminated dermatosis involving the trunk and limbs. The dermatosis was characterized by polymorphic erythematous macules and plaques with elevated and indurated borders without evanescence to pressure. Previous treatment included antihistamines and... | [
{
"original_text": "Ziehl-Neelsen and Fite stains were positive for acid-alcohol-fast intracellular bacilli",
"type": "Inclusion"
},
{
"original_text": "Earlobe smear was positive for acid-fast bacilli",
"type": "Differentiation"
},
{
"original_text": "Dysesthesia was recorded on her les... |
49 | DiagnosisArena | Traumatic brain injury with early post-traumatic seizure | === CASE INFORMATION ===
An unhelmeted young man fell from his longboard, hit his head, probably lost consciousness, stood up, and felt a bump. After he returned home, he acted sullen and defiant but had no recollection of the fall. He was intubated for airway protection but was extubated successfully soon thereafter. ... | [
{
"original_text": "fell from his longboard, hit his head, probably lost consciousness",
"type": "Inclusion"
},
{
"original_text": "C) MRI susceptibility-weighted image shows hemorrhagic cortical spots",
"type": "Inclusion"
},
{
"original_text": "- Laboratory tests: pH 7.23, PaCO2 38 mm ... |
50 | DiagnosisArena | Inverse psoriasiform eruption with secondary impetiginization | === CASE INFORMATION ===
A woman in her 80s receiving pembrolizumab treatment (2 mg/kg) for metastatic melanoma of the lung and spine presented with a 2-month history of a worsening vaginal and intergluteal pink-red plaque. She developed the eruption between treatment cycles 2 and 3 of pembrolizumab and was hospitalize... | [
{
"original_text": "extending from her mons pubis to her intergluteal folds",
"type": "Inclusion"
},
{
"original_text": "well-demarcated, thin, pink-red plaque",
"type": "Inclusion"
},
{
"original_text": "Smooth pink-red plaque with a red to violaceous rim",
"type": "Differentiation"... |
51 | DiagnosisArena | Bidirectional ventricular tachycardia due to digoxin effect with concurrent hypokalemia | === CASE INFORMATION ===
A patient in their late 70s with a history of coronary artery disease, paroxysmal atrial fibrillation, hypertension, and long-term treatment with digoxin presented to the emergency department with septic shock and complications of acute respiratory failure that required endotracheal intubation ... | [
{
"original_text": "beat-to-beat alternating axis between +150° and −60°.",
"type": "Inclusion"
},
{
"original_text": "long-term treatment with digoxin",
"type": "Inclusion"
},
{
"original_text": "Serum potassium: 3.1 mEq/L (reference range: 3.5-5.1 mEq/L)",
"type": "Inclusion"
},
... |
52 | DiagnosisArena | Progressive mucinous histiocytosis (PMH) | === CASE INFORMATION ===
A woman in her 30s presented with a chronic history of slowly expanding asymptomatic papules on the dorsal hands since childhood, with more recent involvement of both forearms. She denied photosensitivity, arthritis, or muscle weakness.
=== PHYSICAL EXAMINATION ===
Multiple discrete reddish-br... | [
{
"original_text": "Results of S-100 protein and CD1a stains were negative.",
"type": "Exclusion"
},
{
"original_text": "Complete blood cell count, lipid profile, serum protein electrophoresis, antinuclear antibody, extractable nuclear antigen, and serum tryptase were all unremarkable.",
"type":... |
53 | DiagnosisArena | Juvenile-onset neuronal intranuclear inclusion disease (NIID) | === CASE INFORMATION ===
A 19-year-old Chinese man presented with 3 days of acute onset of fever, headache, convulsion, encephalopathy, nausea, and vomiting. After 48 hours, the patient's mental status improved. Medical history revealed that extrapyramidal symptoms had gradually developed in the preceding 6 years, and ... | [
{
"original_text": "Ubiquitin-positive intranuclear inclusions in dermal cells",
"type": "Inclusion"
},
{
"original_text": "Intranuclear inclusions in nuclei of dermal cells",
"type": "Inclusion"
},
{
"original_text": "Normal lactate",
"type": "Differentiation"
}
] |
54 | DiagnosisArena | Macular lymphocytic arteritis | === CASE INFORMATION ===
A woman in her early 20s presented with 1 year of discrete asymptomatic brown lesions distributed over her lower extremities. She denied any history of trauma or prior lesions at these sites and could not pinpoint any exacerbating or alleviating factors. She denied fever, arthralgias, myalgias,... | [
{
"original_text": "Verhoeff-van Gieson stain revealed an intact elastic lamina",
"type": "Inclusion"
},
{
"original_text": "Mononuclear inflammation and fibrosis around vessels at the junction of the deep dermis and subcutis",
"type": "Inclusion"
},
{
"original_text": "deep dermal vesse... |
55 | DiagnosisArena | Infranodal second-degree type 1 AV block | === CASE INFORMATION ===
A patient in their mid-70s with a medical history of hypertension and no known history of cardiac disease presented with recurrent syncopal attacks.
=== PHYSICAL EXAMINATION ===
Orthostatic blood pressure was unremarkable. Additional routine cardiac evaluation showed no significant findings.
... | [
{
"original_text": "Standing ECG showed second-degree type 1 AV conduction block with a 5:4 conduction ratio",
"type": "Inclusion"
},
{
"original_text": "right bundle-branch block",
"type": "Differentiation"
},
{
"original_text": "Notable finding: Worsened AV conduction with exercise",
... |
56 | DiagnosisArena | Arnold nerve neuropathy due to tympanostomy tube irritation | === CASE INFORMATION ===
An 11-year-old boy underwent bilateral tympanostomy tube placement (beveled Armstrong type) and adenoidectomy for recurrent acute otitis media despite prior placement of tympanostomy tubes. The day after surgery, he developed symptoms requiring emergency department evaluation. He had multiple h... | [
{
"original_text": "An 11-year-old boy underwent bilateral tympanostomy tube placement (beveled Armstrong type)",
"type": "Inclusion"
},
{
"original_text": "The day after surgery, he developed symptoms requiring emergency department evaluation.",
"type": "Inclusion"
},
{
"original_text":... |
57 | DiagnosisArena | Eosinophilic annular erythema (EAE) | === CASE INFORMATION ===
A woman in her 70s with recurrent primary peritoneal carcinoma receiving pembrolizumab and ipilimumab presented with a pruritic rash ongoing for 2 weeks. The rash started as an erythematous papule on her right arm 2 months after initiation of a new immunotherapy regimen, then gradually enlarged... | [
{
"original_text": "Erythematous annular plaques without scale",
"type": "Inclusion"
},
{
"original_text": "superficial and deep perivascular and interstitial inflammation with numerous eosinophils",
"type": "Differentiation"
},
{
"original_text": "Periodic acid–Schiff (PAS) stain was ne... |
58 | DiagnosisArena | Atrial flutter with 1:1 conduction | === CASE INFORMATION ===
A man in his 70s with history of atrial flutter treated with metoprolol succinate (without anticoagulation), heart failure with preserved ejection fraction, hypertension, and type 2 diabetes. He presented with intermittent palpitations and dyspnea occurring daily for 1 month, most consistently ... | [
{
"original_text": "Atrial rate equal to ventricular rate (252 activations per minute)",
"type": "Inclusion"
},
{
"original_text": "Typical atrial flutter with 2:1 conduction",
"type": "Inclusion"
},
{
"original_text": "Wide QRS (>120 ms) complex tachycardia",
"type": "Differentiatio... |
59 | DiagnosisArena | Anastrozole-associated uveitis with cystoid macular edema | === CASE INFORMATION ===
A 65-year-old woman presented with blurry vision in her right eye for several months. Ocular history included 3 recurrent episodes of bilateral iritis occurring during 5 months, amblyopia in the left eye, and bilateral posterior chamber intraocular lens. Patient had undergone left-sided mastect... | [
{
"original_text": "2+ fine keratic precipitates, and 1+ cells in the anterior chamber.",
"type": "Inclusion"
},
{
"original_text": "3 recurrent episodes of bilateral iritis occurring during 5 months",
"type": "Inclusion"
},
{
"original_text": "Right eye showed significant cystoid macula... |
60 | DiagnosisArena | Ostium secundum atrial septal defect (OS-ASD) | === CASE INFORMATION ===
A 29-year-old primigravida woman presented to the outpatient obstetric clinic for a routine antenatal checkup. There was no history of dyspnea, chest pain, palpitation, or lower limb swelling. Her vital parameters were within normal limits.
=== PHYSICAL EXAMINATION ===
Cardiovascular system ex... | [
{
"original_text": "Large 21-mm defect with left-to-right shunt",
"type": "Inclusion"
},
{
"original_text": "Step-up in oxygenation from superior vena cava (71%) and inferior vena cava (77%) to right atrium (84%)",
"type": "Inclusion"
},
{
"original_text": "Dilated right atrium and right... |
61 | DiagnosisArena | Neurocristic hamartoma | === CASE INFORMATION ===
A 17-month-old boy presented with a slow-growing, nontender plaque on the lower back. The plaque was initially 1 × 1 cm and had grown with the child. Medical history included dermal melanocytosis of the right hip and mid back, increased head circumference (97th percentile), and expressive langu... | [
{
"original_text": "Immunohistochemical staining showed diffuse and periadnexal S100 positivity in the mid to deep dermis",
"type": "Inclusion"
},
{
"original_text": "Partial expression of Melan A",
"type": "Inclusion"
},
{
"original_text": "Positive for CD34, SOX-10",
"type": "Inclu... |
62 | DiagnosisArena | Type I cryoglobulinemia associated with multiple myeloma | === CASE INFORMATION ===
A woman in her 80s with a history of nonischemic cardiomyopathy and chronic kidney disease presented with purpuric lesions on her face, elbows, knees, and feet. She was initially admitted for altered mental status in the setting of an unwitnessed fall and was noted to have 'bruises' on her lowe... | [
{
"original_text": "Monoclonal IgG-κ protein on immunofixation electrophoresis",
"type": "Inclusion"
},
{
"original_text": "Elevated serum cryoglobulin levels (cryocrit, 16%)",
"type": "Inclusion"
},
{
"original_text": "Four-millimeter punch biopsy specimens from left ear, right arm, and... |
63 | DiagnosisArena | Synchysis scintillans with morning glory disc anomaly and chronic retinal detachment | === CASE INFORMATION ===
A young girl presented with a blind right eye that developed spontaneous hyphema and vitreous hemorrhage. Multiple glistening crystals were observed in the anterior chamber. As the hyphema resolved, the number of aqueous crystals increased.
=== PHYSICAL EXAMINATION ===
Examination revealed mul... | [
{
"original_text": "multiple, iridescent, needle-like crystals floating freely within the aqueous of the right eye.",
"type": "Inclusion"
},
{
"original_text": "As the hyphema resolved, the number of aqueous crystals increased.",
"type": "Inclusion"
},
{
"original_text": "spontaneous hyp... |
64 | DiagnosisArena | Tertiary amine-induced epithelial keratopathy | === CASE INFORMATION ===
A man in his 40s reported bilateral blurry vision and photophobia for the 2 days since he sprayed polyurethane foam insulation. He denied direct ocular exposure and had used a respirator with a face shield.
=== PHYSICAL EXAMINATION ===
Examination revealed numerous discrete intraepithelial cor... | [
{
"original_text": "sprayed polyurethane foam insulation",
"type": "Inclusion"
},
{
"original_text": "He denied direct ocular exposure and had used a respirator with a face shield.",
"type": "Inclusion"
},
{
"original_text": "Numerous discrete interpalpebral corneal opacities (A), locali... |
65 | DiagnosisArena | Apocrine poroma | === CASE INFORMATION ===
A man in his 30s with no medical history of illness presented with a lesion on his left scalp. The patient noted that the lesion had slowly enlarged over the preceding 5 years from when he first noticed it as a small bump. He denied a history of trauma prior to its development. The patient deni... | [
{
"original_text": "Some tumor islands contained mature sebocytes and ductal structures with an eosinophilic cuticle.",
"type": "Differentiation"
},
{
"original_text": "Some tumor islands contained mature sebocytes",
"type": "Differentiation"
},
{
"original_text": "Revealed epidermal pro... |
66 | DiagnosisArena | Intralymphatic histiocytosis | === CASE INFORMATION ===
A man in his 80s presented with an 18-month history of skin changes. The patient complained about a mild tingling sensation within the lesion. He denied any triggers, causes, aggravating or alleviating factors, and had not attempted any treatments. Review of systems was negative except for easy... | [
{
"original_text": "Dense, nodular infiltrate of lymphocytes and histiocytes throughout the dermis and within thin-walled lymphatic vessels.",
"type": "Inclusion"
},
{
"original_text": "Immunohistochemical staining for CD68 antigen revealed infiltrate composed mostly of histiocytes",
"type": "In... |
67 | DiagnosisArena | Septic shock with anuric kidney failure | === CASE INFORMATION ===
A woman in her 80s presented to the emergency department with altered mental status, weakness, slurred speech, emesis, and headache. Emergency medical services found her pulse rate in the 20s. Her initial vital signs in the emergency department were blood pressure of 100/73 mm Hg, heart rate of... | [
{
"original_text": "Chest radiography: Showed pulmonary consolidation",
"type": "Inclusion"
},
{
"original_text": "altered mental status",
"type": "Inclusion"
},
{
"original_text": "Patient required intubation for airway protection.",
"type": "Inclusion"
},
{
"original_text":... |
68 | DiagnosisArena | Tear of the rectus femoris muscle presenting as a pseudotumor | === CASE INFORMATION ===
A healthy young woman presented with a 2-month history of an enlarging right anterior thigh subcutaneous mass. The lesion was asymptomatic but had grown significantly. She ran recreationally and recalled no trauma to the area.
=== PHYSICAL EXAMINATION ===
A 4-cm firm subcutaneous mass was palp... | [
{
"original_text": "The mass was palpable with right hip flexion and disappeared on right hip extension.",
"type": "Differentiation"
},
{
"original_text": "Demonstrated focal bulging of the fascia of the right anterior thigh musculature with flexion and resultant convexity of the rectus femoris at t... |
69 | DiagnosisArena | Pagetoid reticulosis (Woringer-Kolopp disease) | === CASE INFORMATION ===
A preschool-age girl presented with an asymptomatic plaque on the right lower extremity that had been present for 1 year. Prior treatments included triamcinolone ointment and frankincense with no improvement. A potassium hydroxide preparation had negative results for fungal elements. Her medica... | [
{
"original_text": "Solitary plaque on the right lateral lower leg",
"type": "Inclusion"
},
{
"original_text": "Marked epidermotropism of atypical lymphocytes with irregular nuclear contours and halos, both singly and in small collections (Pautrier microabscesses)",
"type": "Inclusion"
},
{
... |
70 | DiagnosisArena | Cholecystocardial syndrome (CCS) due to poorly differentiated adenocarcinoma of the pancreaticoduodenal junction | === CASE INFORMATION ===
A male patient in their early 50s with no history of prior known diseases was admitted with epigastric pain and jaundice of 2 weeks. On the third day of admission, the patient experienced a sudden squeezing pain in the anterior chest at rest, with a heart rate of 44 beats/min, blood pressure of... | [
{
"original_text": "a sudden squeezing pain in the anterior chest at rest",
"type": "Differentiation"
},
{
"original_text": "Complete atrioventricular block with 4-5mm ST-segment elevation in leads II, III, and aVF; 3-6mm ST-segment depression in leads I, aVL, and V1 through V5",
"type": "Inclus... |
71 | DiagnosisArena | Poikilodermatous mycosis fungoides (PMF) stage IB disease | === CASE INFORMATION ===
A man in his 40s with a 5-year history of mildly pruritic poikilodermatous patches and thin plaques involving the bilateral axilla and groin presented with expanding lesions on both flanks. He had not received any prior treatment for the lesions. Review of systems was unremarkable.
=== PHYSICA... | [
{
"original_text": "hypopigmented and hyperpigmented reticulated patches and thin, atrophic plaques covering more than 10% of the total body surface area",
"type": "Inclusion"
},
{
"original_text": "No cervical, axillary, or inguinal lymphadenopathy was noted.",
"type": "Exclusion"
},
{
... |
72 | DiagnosisArena | Three-vessel obstructive coronary artery disease | === CASE INFORMATION ===
A 53-year-old man reported substernal chest pain, lasting less than 5 minutes, which sometimes occurred if he ran more than 2 miles. Medical history included hypertension (controlled with lisinopril and hydrochlorothiazide), LDL of 155 mg/dL, and HDL of 44 mg/dL. He did not smoke and had no fam... | [
{
"original_text": "CCTA (Computed Tomography Angiogram): Demonstrated 3-vessel involvement",
"type": "Inclusion"
},
{
"original_text": "PET-MPI (Positron Emission Tomography-Myocardial Perfusion Imaging): Showed severe ischemia in the distribution of the left anterior descending and circumflex arte... |
73 | DiagnosisArena | Cytomegalovirus (CMV) cutaneous ulcers | === CASE INFORMATION ===
A woman in her 80s presented with somnolence and fatigue of 2 days' duration. Medical history included lower urinary tract symptoms of 1-week duration for which she was prescribed cotrimoxazole with no improvement. She reported progressively worsening vulvar and buttock pain of 5 days' duration... | [
{
"original_text": "Immunohistochemical staining positive for CMV",
"type": "Inclusion"
},
{
"original_text": "Biopsy from left vulvar ulcer showing dense mixed inflammatory cell infiltrates with enlarged endothelial cells",
"type": "Inclusion"
},
{
"original_text": "Quantitative plasma ... |
74 | DiagnosisArena | Nonkeratinizing squamous cell carcinoma of the nasal mucosa with Schneiderian features | === CASE INFORMATION ===
A woman in her 50s who was a never-smoker presented with an enlarged, firm right ala. She first noticed a lesion of the right nasal vestibule mucosa 5 years prior. At that time, the lesion was biopsied and reported as a solid and cystic hidradenoma that was p63 positive, pancytokeratin positive... | [
{
"original_text": "Downward papillomatous proliferation of small, uniform, slightly atypical keratinocytes within loose stroma",
"type": "Inclusion"
},
{
"original_text": "p63 positive",
"type": "Inclusion"
},
{
"original_text": "pancytokeratin positive",
"type": "Differentiation"
... |
75 | DiagnosisArena | Foreign body (bee stinger) embedded in the laryngeal surface of the epiglottis | === CASE INFORMATION ===
An adolescent presented to the clinic with sudden and persistent throat pain and right-sided otalgia that occurred after something flew into the patient's throat. The patient reported coughing at the onset of the event, which subsided shortly thereafter. As witnessed by the patient's parents, t... | [
{
"original_text": "Flexible laryngoscopic examination provided visualization of a small foreign body embedded in the laryngeal surface of the epiglottis.",
"type": "Inclusion"
},
{
"original_text": "Bee stinger (arrowhead) seen on laryngoscopic examination.",
"type": "Inclusion"
},
{
"o... |
76 | DiagnosisArena | Low-grade chondrosarcoma of the mastoid with facial nerve involvement | === CASE INFORMATION ===
A man in his 60s presented with a 2-year history of gradual-onset right facial weakness leading to paralysis. He was initially treated with oral steroids. At presentation, he denied hearing loss, tinnitus, imbalance, or other cranial nerve deficits. He had no other significant medical history.
... | [
{
"original_text": "2 × 1.5 × 0.5-cm tan to brown, rubbery specimen consisted of cartilage",
"type": "Inclusion"
},
{
"original_text": "Microscopic image showing increased numbers of atypical pleomorphic nuclei in a myxochondroid matrix.",
"type": "Inclusion"
},
{
"original_text": "Low c... |
77 | DiagnosisArena | Deficiency of the interleukin-36 receptor antagonist (DITRA) | === CASE INFORMATION ===
A male adolescent with skin manifestations since infancy and multiple hospitalizations. Throughout his life, his condition initially responded to multiple systemic and biologic agents that subsequently failed. Current medications included oral methotrexate, 10 mg/wk, and intravenous infusion of... | [
{
"original_text": "- Genomic DNA analysis revealed homozygous mutation within the IL36RN gene at position c.115+6T>C",
"type": "Inclusion"
},
{
"original_text": "- Heterozygous c.115+6T>C mutation confirmed in patient's mother",
"type": "Inclusion"
},
{
"original_text": "erythroderma an... |
78 | DiagnosisArena | Eosinophilic annular erythema (EAE) | === CASE INFORMATION ===
An 83-year-old woman presented since 2006 with a generalized pruritic eruption comprising annular and polycyclic plaques on the face, neck, trunk, and extremities with changing appearance. The patient was evaluated and received care at Ciudad Real University General Hospital beginning in 2014.
... | [
{
"original_text": "superficial and deep perivascular and interstitial lymphocytic inflammation with numerous eosinophils",
"type": "Differentiation"
},
{
"original_text": "a generalized pruritic eruption comprising annular and polycyclic plaques",
"type": "Inclusion"
},
{
"original_text... |
79 | DiagnosisArena | Overlap of bullous pemphigoid, anti-p200 pemphigoid, and anti-laminin-332 mucous membrane pemphigoid with anti-CNTN1-positive inflammatory polyneuropathy | === CASE INFORMATION ===
A 77-year-old man initially presented in 2011 with tense bullae on the back and extremities. After treatment and being symptom-free for 5 years, in 2017 he developed new erosions and tense bullae, mainly on the palate and feet. During hospitalization, the patient developed a progressive tetrapa... | [
{
"original_text": "A 77-year-old man",
"type": "Inclusion"
},
{
"original_text": "subepidermal bulla",
"type": "Inclusion"
},
{
"original_text": "Neutrophil- and eosinophil-rich infiltrate",
"type": "Inclusion"
},
{
"original_text": "Linear deposition of IgG at the epidermal... |
80 | DiagnosisArena | Orthodromic Atrioventricular Reentrant Tachycardia (AVRT) with left posterior accessory pathway | === CASE INFORMATION ===
A patient in their 40s presented to the emergency department with sudden-onset rapid palpitations at rest. The patient recalled similar episodes in the past that had terminated spontaneously.
=== PHYSICAL EXAMINATION ===
Heart rate was 210 beats/min at presentation, and blood pressure was 110/... | [
{
"original_text": "Regular narrow complex tachycardia at 190 beats/min",
"type": "Inclusion"
},
{
"original_text": "1:1 AV conduction",
"type": "Inclusion"
},
{
"original_text": "Inverted P waves in inferior leads away from QRS complex.",
"type": "Differentiation"
},
{
"orig... |
81 | DiagnosisArena | Disseminated Strongyloides stercoralis infection with ocular involvement (choroiditis) | === CASE INFORMATION ===
An individual around 60 years old living in a rural area in the southeastern US was hospitalized with altered mental status, fever, flaccid paralysis of all extremities, and respiratory failure with lower lobe nodules and a left lower lobe infiltrate. Medical history included porphyria with pol... | [
{
"original_text": "for which they received oral prednisone before admission.",
"type": "Inclusion"
},
{
"original_text": "Multiple organ involvement including lungs, liver, pancreas, colon, appendix, and kidneys",
"type": "Inclusion"
},
{
"original_text": "Pseudomonas aeruginosa",
"... |
82 | DiagnosisArena | Severe Hyperkalemia | === CASE INFORMATION ===
A patient in their 60s was admitted to the intensive care unit for gastrointestinal bleeding and shock. Medical history includes liver cirrhosis and portal hypertension with ruptured esophageal varices. Despite fluid resuscitation and pressors, blood pressure continued to fall and kidney functi... | [
{
"original_text": "Serum potassium level > 9.0 mmol/L (normal: 3.6-5.4 mmol/L)",
"type": "Inclusion"
},
{
"original_text": "Prominent and tented T waves",
"type": "Inclusion"
},
{
"original_text": "Very slow wide-complex rhythm without P waves",
"type": "Inclusion"
},
{
"ori... |
83 | DiagnosisArena | Enhanced S-cone syndrome (ESCS) | === CASE INFORMATION ===
A 42-year-old patient with night blindness since childhood. The patient has been followed for 30 years, with initial presentation at age 10. The patient reports no symptoms except night blindness and is unaware of field loss. Past medical history is unremarkable.
=== PHYSICAL EXAMINATION ===
-... | [
{
"original_text": "Few yellow spots present, no pigmentary degeneration",
"type": "Exclusion"
},
{
"original_text": "Goldmann visual field: Inferonasal scotoma",
"type": "Differentiation"
},
{
"original_text": "Central macula: Clear OCT layers",
"type": "Exclusion"
},
{
"ori... |
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Med-Evidence-2.6k
Med-Evidence-2.6k is a benchmark for evaluating evidence-grounded medical diagnostic reasoning. It was developed as part of the work EviDx: Evidence-Aware Active Diagnosis with Scaffolded LLM Agents, accepted to Findings of EMNLP 2026.
The benchmark provides clinical diagnostic questions paired with ground-truth answers and annotated evidence spans, enabling evaluation of both diagnostic accuracy and evidence-grounded reasoning.
Dataset Structure
Med-Evidence-2.6k currently contains three subsets:
- DiagnosisArena
- JAMA
- MedXpertQA-Text
Note: During dataset curation, we selected 234 diagnosis-related cases from MedXpertQA-Text and annotated evidence for this subset.
Each subset is provided as a separate Hugging Face configuration.
from datasets import load_dataset
dataset = load_dataset(
"danieez/Med-Evidence-2.6k",
"DiagnosisArena"
)
print(dataset["test"][0])
The other subsets can be loaded by replacing "DiagnosisArena" with "JAMA" or "MedXpertQA-Text".
Data Format
Each example follows a unified schema:
{
"original_id": "Text-107",
"dataset": "MedXpertQA-Text",
"ground_truth_text": "Truncus arteriosus",
"question_text": "A male neonate, aged 2 weeks, ...",
"golden_evidence": [
{
"original_text": "a single S2",
"type": "Inclusion"
},
{
"original_text": "all peripheral pulses are bounding",
"type": "Differentiation"
}
]
}
Fields
| Field | Description |
|---|---|
original_id |
Identifier of the example in the original source dataset. |
dataset |
Name of the source subset in Med-Evidence-2.6k. |
ground_truth_text |
Ground-truth diagnosis or answer. |
question_text |
Full clinical question or case description presented to the model. |
golden_evidence |
Annotated evidence spans relevant to the ground-truth answer. |
golden_evidence.original_text |
Evidence span extracted directly from the question text. |
golden_evidence.type |
Functional type of the evidence in diagnostic reasoning. |
Intended Use
Med-Evidence-2.6k is intended for research on:
- medical diagnostic reasoning;
- evidence identification and extraction;
- evidence-grounded question answering;
- evaluation of clinical reasoning in large language models.
The dataset supports separate or joint evaluation of diagnostic answer correctness and evidence selection.
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