Each month, we will present a challenging Case of the Month for The Green Journal readers, who must use their clinical acumen to arrive at the correct answer. We will also post the case each month on the Journal’s web site (http://www.elsevier.com/locate/ajmselect). Several possible answers may be consistent with the case presentation; use your best judgment. Please send your answer (one per respondent) and indicate the case to which you are responding to The Green Journal at editors@amjmed.org or via FAX to (415) 447-2799. Only those answers with a complete mailing address will be considered. The correct answer will appear in the May issue of the Journal. The first five persons who submit correct answers will receive a free one-year subscription to the Journal. Colleagues of Dr. Alsafwah are not eligible for this month’s case. If you would like to contribute a case, please submit a brief synopsis (<250 words) to the editorial office. An individual may win only once per calendar year.