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The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF MICHIGAN on April 23, 2013. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2009 Massachusetts Medical Society. All rights reserved.

Case 48-1966

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Page 1: Case 48-1966

The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF MICHIGAN on April 23, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2009 Massachusetts Medical Society. All rights reserved.

Page 2: Case 48-1966

The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF MICHIGAN on April 23, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2009 Massachusetts Medical Society. All rights reserved.

Page 3: Case 48-1966

The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF MICHIGAN on April 23, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2009 Massachusetts Medical Society. All rights reserved.

Page 4: Case 48-1966

The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF MICHIGAN on April 23, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2009 Massachusetts Medical Society. All rights reserved.

Page 5: Case 48-1966

The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF MICHIGAN on April 23, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2009 Massachusetts Medical Society. All rights reserved.

Page 6: Case 48-1966

The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF MICHIGAN on April 23, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2009 Massachusetts Medical Society. All rights reserved.

Page 7: Case 48-1966

The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF MICHIGAN on April 23, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2009 Massachusetts Medical Society. All rights reserved.

Page 8: Case 48-1966

The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF MICHIGAN on April 23, 2013. For personal use only. No other uses without permission.

From the NEJM Archive. Copyright © 2009 Massachusetts Medical Society. All rights reserved.