Case Presentation: A 5–year–old white female presented to the ED with 3 day history of vomiting. She has had two week history of upper respiratory symptoms prior to the onset of vomiting. The emesis was non–bilious and non–bloody. There was no diarrhea. ROS was noted for fever, cough, vomiting, and headaches. CXR was negative for [...]

Case Presentation: A 60–year–old male with sarcoidosis and cryptogenic cirrhosis presented with increasing dyspnea and abdominal distention. He underwent a therapeutic and diagnostic paracentesis. The cell count was consistent with spontaneous bacterial peritonitis (cloudy fluid with 1590 WBC and 67% neutrophils and 28% lymphocytes). The cultures grew ceftriaxone susceptible salmonella non typhi (serotype 4512i). Following [...]

Case Presentation: An 85–year–old man received the last of twelve treatments of intravesical Bacillus Calmette–Guérin (BCG) for transitional cell carcinoma of the bladder. Urinary catheter placement was difficult and complicated by hematuria. Over the next week, he developed fever, malaise and anorexia. His primary physician admitted him to a local hospital, where he was noted [...]

Case Presentation: A 59–year–old Caucasian male with bipolar disorder presented to an outside hospital with altered mental status, generalized weakness, and lower extremity paralysis after a day of significant physical exertion. Physical exam revealed an absence of muscle tone and sensation in his bilateral lower extremities. Laboratory evaluation indicated rhabdomyolysis (CK 28,000), an acute kidney [...]

Case Presentation: BG was a 35 week preemie via C/S to a 23–year–oldo G2P1 mom due to preterm labor. Pregnancy was complicated by a progressively dilated loop of bowel without haustrations and only very occasional peristalsis seen on prenatal sonograms from 34 weeks AOG. At delivery BG had a firm distended stomach. An OG tube [...]

Case Presentation: A 42–year–old man with no past medical history presented with right sided abdominal pain of 8 hours duration. He denied dysuria, frequency, or urinary urgency. He was afebrile and his blood pressure was 156/96 mmHg. His white blood cell count was elevated to 10.8 K per microliter. Serum creatinine was 1.0 mg/dL. Given [...]

Case Presentation: A 78–year–old man with metastatic follicular thyroid cancer status post thyroidectomy and radioactive iodine ablation in 2008 was admitted to the hospital for atypical chest pain and back pain for 2 weeks. He had a past history of atrial fibrillation on anticoagulation, diastolic congestive heart failure, hypocalcemia on calcitriol, and anxiety. The patient [...]

Case Presentation: 74–year–old man presents with blue–gray discoloration of the face, neck and upper thorax. The patient had a history of esophageal adenocarcinoma, completing definitive chemo radiation in 2006. His presenting complaint was of weight loss and early satiety for which endoscopic evaluation revealed numerous brown pigmented circumscribed lesions. He had noted tarry, brown stool [...]

Case Presentation: A 69–year–old lady with metastatic breast cancer presents with 2 months of leg edema and abdominal swelling. Initially diagnosed and treated 13 years earlier, she had recurrence of invasive ductal carcinoma 3 years ago with metastases to the liver, lung, soft tissue, and bone. She has been actively receiving chemotherapy with cyclophosphamide and [...]

Case Presentation: An 82–year–old female with a medical history notable for dementia, type 2 diabetes mellitus, hypertension, hyperlipidemia, cerebrovascular accident, gastroesophageal reflux, and gastric ulcers secondary to Stevens Johnson syndrome was brought into the emergency department by her son with slurred speech for two days The patient’s had been taking omeprazole 40 mg twice daily [...]