Case Presentation: Patient is a 73-year-old female with history of hypertension, chronic back pain on gabapentin, prior intravenous drug use, peripheral artery disease status post bilateral femoral endarterectomies with stenting on dual anti-platelet therapy who presented to the emergency department with right lower extremity pain. Patient was hemodynamically stable, alert and oriented. Shortly after undergoing [...]

Case Presentation: A 43-year-old man with ankylosing spondylitis (on adalimumab), presented with 2-days of fever, cough, diarrhea, and encephalopathy. He had no significant travel history. On exam, he was tachycardic (P = 120 bpm), febrile (temperature 103.0oF), tachypneic (RR = 30 bpm) and had left-sided crackles. Notable labs: WBC = 12.3 109/L, Na+ = 130 [...]

Case Presentation: A 58-year-old Spanish-speaking, uninsured man presents to primary care for a rash and is diagnosed with poison ivy and treated with prednisone. He eventually presents to the emergency department with ulcerative, crusting lesions of his right nasal ala, eyelid, scalp, philtrum, and lips. The lesions overlay a desquamative rash that covers his right [...]

Case Presentation: A 70-year-old woman with a past medical history of CKD stage IV, nephrolithiasis, Crohn’s disease presented to the Emergency department for two weeks of nausea, anorexia, dehydration, fever, chills, lightheadedness with right upper quadrant pain. Upon admission the patient was in shock, differentials included septic vs cardiogenic. BNP was 354 pg/mL and troponin [...]

Case Presentation: A 26-year-old female refugee from Afghanistan with a history of menorrhagia presented after a near syncopal episode and two days of fever, chills, and tooth pain. Per cultural preference, history was obtained from the patient’s husband using interpretive services. He reported that the patient developed cold extremities, fatigue, decreased appetite, weight loss, and [...]

Case Presentation: A 48-year-old female with past medical history including obesity, T2DM, and tobacco use presented with right eye swelling, pain, and vision loss. She began noticing a dark spot in her right eye about three months prior, which progressed to a pressure-like sensation. A CTA of head and neck showed cavernous sinus hyperdensity. MRI [...]

Case Presentation: An 18-year-old male with no significant past medical history presented with four days of worsening fever, sore throat, nausea, vomiting, headache, and difficulty swallowing. One month prior, he presented to an urgent care with an enlarged tender lump below his chin and swollen lymph nodes. He was diagnosed with infectious mononucleosis (IM) and [...]

Case Presentation: 26 yo M with X-linked agammaglobulinemia admitted for RLE extremity non healing wound and abdominal distention found to have hepatosplenomegaly (liver 23 cm), moderate to large ascites, transaminitis (ALP 300, AST/ALT 43/12), hyperbilirubinemia (T bili 6.5->7.5), coagulopathy (INR 1.75 with pancytopenia. On ultrasound porto-systemic collaterals and splanchnic vessels were reported patent. MRI abdomen [...]

Case Presentation: An 80-year-old female with a history significant for breast cancer status post mastectomy with chemo/radiation therapy and phenytoin-induced liver injury in 2013 presented with nine months of weakness, weight loss, and 2-3 month history of confusion, memory loss, and widespread tremors, suspicious for focal status epilepticus. Workup revealed hyponatremia (135 mmol/L) and elevated [...]

Case Presentation: A 76-year-old white woman with a past medical history of RA, being treated with MTX, sarilumab, and folic acid supplementation, presented to the hospital for worsening pain and lethargy. Physical exam displayed dry mucous membranes, ulcerations throughout the oropharynx, and purple digits from distal interphalangeal joints to the fingernails bilaterally. Additionally, she was [...]