Case Presentation: A 34yo with alcohol-induced cirrhosis presented with fatigue. She had a hemoglobin (Hb) of 5.3g/dl, creatinine 3.43mg/dl (baseline 0.5), and total bilirubin 20.4mg/dl with a MELD of 40. Workup showed no GI bleeding. Large volume paracentesis (LVP) was performed with clear yellow fluid removed and no evidence of spontaneous bacterial peritonitis. She was [...]

Case Presentation: A 64-year-old woman with a history of sickle cell disease (SCD) from hemoglobin-SS, prior avascular necrosis (AVN) of bilateral hips and humeral heads and prior stroke on chronic exchange transfusions, was brought in by her family for acute confusion and possible increased right-sided weakness. She also reported lower extremity (LE) pain. Neurology consulted [...]

Case Presentation: A 73-year-old with history of Cushing’s disease status post left adrenalectomy presented to the emergency department with severe weakness, increased thirst and dizziness for one week. On presentation, her blood pressure was 89/67 and heart rate was 106. On exam, she appeared hypovolemic with dry mucous membranes. Initial laboratory studies showed a sodium [...]

Case Presentation: A 75-year-old woman with hypertension presented to the emergency department with months of progressive diarrhea. She reported a 9-month history of non-bloody loose stools, which fluctuated from one to ten episodes per day, and resulted in an unintentional 40-pound weight loss.Outpatient evaluation included negative Clostridioides difficile toxin, gastrointestinal pathogen panel, and ova and [...]

Case Presentation: A 49-year-old female presented with confusion. Her family reported possible intravenous drug use, but she had no memory of preceding events. She was unable to form new memories. Review of systems was normal but limited by recall. She was afebrile, normotensive, not tachycardic, and saturating well on room air. Heart rhythm was regular, [...]

Case Presentation: A 73-year-old female with hypertension, chronic kidney disease (CKD), hyperlipidemia, type 2 diabetes, obesity, and hiatal hernia presented with 2 days of acute onset epigastric pain with associated nausea, non-bloody non-bilious vomiting, diarrhea, dysphagia, odynophagia, and inability to tolerate oral intake. She described the pain as constant and progressive. Her history included a [...]

Case Presentation: 71 y/o male with a past medical history of ITP, CKD, HTN presents with a five month history of unresolved abdominal pain and diarrhea, in the setting of three ED visits and a prior admission six week ago. The patient notes profuse diarrhea throughout the day and night nausea and vomiting, and an [...]

Case Presentation: A 30-year-old woman presented to her primary care physician for two weeks of fever and flu-like symptoms attributed to an upper respiratory infection. She was prescribed prednisone, hydroxychloroquine, and doxycycline. Fevers as high as 104 degrees Fahrenheit persisted despite acetaminophen use. She developed severe abdominal pain and presented to the hospital. Exam revealed [...]

Case Presentation: A 28-year-old male who was immunosuppressed with Infliximab for Crohn’s disease was seen in the hospital in early summer for non-resolving fever of four-week duration. Blood and urine cultures and computed tomographic (CT) imaging of chest, abdomen and pelvis was negative along with molecular testing for common tick-borne diseases like Anaplasmosis, Babesiosis, respiratory [...]

Case Presentation: A 65-year-old man presented with four months of fever, neutropenia, macrocytic anemia, thrombocytopenia, and recurrent inflammatory manifestations. Between August–December 2023, he experienced multiple hospitalizations for presumed infections (orbital and ankle cellulitis), steroid-responsive gastrointestinal symptoms, petechial rash, pulmonary infiltrates, and bilateral eye pain. Workup revealed weakly positive Francisella tularensis IgG, PET/CT with diffuse marrow [...]