Case Presentation: 39-year-old man with PMH of HIV presents to the ER with chief complaints of progressive headaches for 4 days associated with projectile vomiting about 50 times/day. The patient reported that he has not taken anti-HIV medication for a few years, he started to take Biktarvy (bictegravir, emtricitabine, and tenofovir alafenamide) 3 months ago [...]

Case Presentation: A 54-year-old man with diabetes, coronary artery disease, peripheral artery disease, and prior stroke presented from a skilled-nursing facility with fever, confusion, and purulent drainage from a left transmetatarsal amputation stump. He was tachycardic, hyperglycemic (468 mg/dL), and had leukocytosis of 42 K/µL with creatinine 1.14 mg/dL. CT of the ankle demonstrated a [...]

Case Presentation: A 38-year-old man without stable housing presented with severe anasarca, a diffuse rash, cytopenias, and acute kidney injury. He had recently trekked the Appalachian Trail. On admission, he was febrile at 38.5°C and tachycardic at 118 beats per minute. He was profoundly edematous, with tense ascites and bilateral pleural effusions on imaging. Laboratory [...]

Case Presentation: A 61-year-old woman with MEN1 (with associated hyperparathyroidism, parathyroid adenoma and pituitary microadenoma) and prior gastric carcinoid resection presented with 4 weeks of progressive exertional dyspnea, painful bilateral leg edema, and fatigue. She had not seen a doctor in 6 years, smoked cigarettes daily, and had not received routine cancer screening. Review of [...]

Case Presentation: A 37-year-old male with a past medical history of chronic sinusitis, gastrointestinal dysmotility, and right upper lobe cavitary pneumonia presented with one week of fevers, five-pound weight loss, and new left-sided chest pain. The patient was using an aerosolized nasal saline spray for chronic sinusitis prior to presentation. Review of systems was positive [...]

Case Presentation: A 51-year-old woman with a history of rheumatoid arthritis and laparoscopic adjustable gastric band surgery presented to the hospital with right-sided paraesthesias, tachycardia, and palpitations after eating. During admission, vitals were normal, except for a heart rate ranging from 90-160 BPM during and after eating. The physical examination was unremarkable. CT/CTA of the [...]

Case Presentation: 91-year-old Caucasian male with dementia, prostatic adenocarcinoma, and chronic urinary retention with an indwelling foley catheter. He was found unresponsive after an unwitnessed fall at his assisted living facility. His family noted progressive cognitive decline with hallucinations over the prior month and a 2-week history of erythematous maculopapular rash on the chest. On [...]

Case Presentation: A 24-year-old woman with type IV glycogen-storage disease and liver transplant presented with fevers, pleuritic chest pain, and odynophagia. On exam, she had multiple ulcers in the posterior pharynx and on bilateral labia majora. Laboratory studies showed elevated NT-proBNP (2717), troponin (367), and CRP above assay (>300). ECG demonstrated nonspecific ST elevations and [...]

Case Presentation: A 52-year-old man with no known medical history presented to the emergency department with four days of worsening neck pain, subjective fevers, fatigue, and new-onset palpitations. He met SIRS criteria for sepsis and was started on empiric broad-spectrum antibiotics with concern for meningitis. CSF studies and cervical spine MRI were unremarkable. During hospitalization, [...]

Case Presentation: A 59-year-old woman with hypertension and dyslipidemia presented with one month of appetite loss, a 5-kg unintentional weight loss, and a week of night sweats. Several days before the onset of appetite loss, she had undergone a tooth extraction for a periapical abscess. On presentation, she was afebrile, hemodynamically stable, and without murmurs. [...]