Case Presentation: A 58-year-old man with HIV on treatment, hepatitis C infection, prior liver transplant (2006) on cyclosporine, atrial fibrillation, CKD stage III, and gout was admitted to the hospital with 48 hours of nuchal rigidity, headache, and fevers up to 101.4 F. He disclosed recent dry needling of his neck and upper back. Exam [...]

Case Presentation: A 33-year-old Filipino male with prior long history of latent tuberculosis, active smoking who presented with one month of progressive abdominal pain, decreased appetite, weight loss, and new periumbilical bruising. Examination revealed a thin, afebrile man with distended abdomen, shifting dullness, and periumbilical ecchymosis. Laboratory studies showed microcytic anemia and thrombocytosis otherwise unremarkable. [...]

Case Presentation: A 48-year-old Native Hawaiian male with end-stage renal disease (ESRD) due to hypertensive nephrosclerosis, status post deceased-donor renal transplant (DDRT) complicated by a post-obstructive small bowel obstruction (2020), presented with a 3-day history of profuse non-bloody watery diarrhea. He reported poor oral intake, subjective fevers, and oliguria but denied nausea, vomiting, or abdominal [...]

Case Presentation: A middle-aged man with chronic HIV on integrase inhibitor–based antiretroviral therapy presented with high fevers, malaise, odynophagia, cough, and emesis. Initial studies revealed pancytopenia (WBC 3.7×10^3/µL, hemoglobin 7.6 g/dL, platelets 47×10^3/µL), elevated LDH, mild hyponatremia, and indirect hyperbilirubinemia. CT imaging showed splenomegaly (15–16 cm) with multistation abdominopelvic lymphadenopathy.Bone-marrow biopsy demonstrated mildly hypercellular marrow [...]

Case Presentation: 57-year-old woman with reflux disease, hypertension and obesity presented with scleral icterus and abnormal liver enzymes two months after starting compounded Tirzepatide. Her baseline hepatic function panel was normal, but after five injections of Tirzepatide her AST/ALT was noted to be elevated to 509/619 U/L. Viral hepatitis panel was negative; workup showed positive [...]

Case Presentation: A 71-year-old woman with a history of bilateral staghorn calculi and morbid obesity presented with progressively worsening left flank pain. Three weeks prior, the patient underwent right-sided ureteroscopy with basket stone extraction and left-sided laser lithotripsy with attempted percutaneous nephrolithotomy following bilateral ureteral stent placement. Prophylactic intravenous (IV) meropenem was given perioperatively due [...]

Case Presentation: A 48-year old woman with a history or ulcerative colitis, on immunotherapy, presented for evaluation of a two-week history of progressive right forearm pain and new-onset hematochezia with right-sided abdominal pain. On admission, she was afebrile and tachycardic, with a severely tender right forearm but no visible erythema or wounds. Laboratory findings were [...]

Case Presentation: A 57-year-old male with rheumatoid arthritis on methotrexate, hydroxychloroquine, and etodolac (NSAID) presented to the emergency room with acute abdominal pain, nausea, and vomiting. Three months prior, the patient had multiple episodes of severe abdominal pain. Colonoscopy and esophagogastroduodenography (EGD) demonstrated gastritis only. Six weeks prior, his gastroenterologist proceeded with video capsule endoscopy [...]

Case Presentation: A 47 year old female with hyperlipidemia and diabetes presented to the ED for syncope, right sided weakness, and aphasia. She was evaluated with CT and CTA head/neck, which was negative for acute stroke but revealed critical left subclavian stenosis and an anomalous origin of the left vertebral artery (LVA) arising from the [...]

Case Presentation: A 52-year-old man with a history of chronic alcohol-induced pancreatitis and biliary strictures requiring multiple biliary stent revisions presented with abdominal pain. The workup was unremarkable with normal white blood cells (WBC) and total bilirubin. On the day of admission, the patient underwent ERCP for biliary stent exchange. He continued to have severe [...]