JHJames H. Brien

1. Article · Aug 26, 2026 · By James H. Brien, DO

   Teen boy with infected hand after fistfight (opens the original)

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   See all articles from What's Your Diagnosis? A healthy, 15-year-old patient injured his right hand during a fistfight after school when he hit the other boy in the mouth. When he got home, the patient’s mother cleaned a small laceration over his fourth metacarpophalangeal (MP) joint (knuckle) and applied a bandage. The next morning, his hand was somewhat swollen with erythema. He was taken to an urgent care clinic where he was found to have a fever of 101.8°F, mild swelling with erythema of h

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2. Article · Jul 24, 2026 · By James H. Brien, DO

   Young boy with itchy, swollen genitals (opens the original)

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   See all articles from What's Your Diagnosis? A 4-year-old boy was evaluated in his family’s primary care clinic in the summer for the sudden onset of swelling of the distal penis. His only symptom was itching, which led to scratching and some discomfort. He initially appeared normal when he came in from playing and went to bed the night before. However, when he woke up early the next morning, he presented with more itching and swelling proximal to the glans as seen in Figure 1. His past medica

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