Papers in the Grand Rounds section are patient case reports and literature review combined in a way that gives them high educational value. The papers lead off with a well-documented case report of an unusual drug experience (e.g., adverse drug reaction, some other unexpected drug response, experimental use of a drug). The case generally deals with a difficult therapeutic problem or dilemma that is commonly encountered but may be overlooked or misunderstood. (Esoteric or rare occurrences of minor importance do not make good Grand Rounds material.) A literature review puts the case in perspective with previously reported similar cases and alternative treatments. The review is integrated with related discussions of the new case being reported.