Case Presentation: A 42–year–old woman with Angelman syndrome, severe cognitive impairment, and seizure disorder presented with changes in mental status. She was nonverbal at baseline; her caregivers had noted less interaction, poor appetite, and 4 hours of increased tremors. She had no fevers or bowel changes. Medications included lamotrigine, phenobarbital, levetiracetam, clonazepam, diazepam, propranolol, hydroxychloroquine, […]

Case Presentation: A 49–year–old man presented with 7 months of progressive ascending lower extremity weakness, numbness, and paresthesias. He also noted worsening right shoulder pain and swelling, gynecomastia, and leg edema. Physical examination was notable for right shoulder edema with decreased range of motion and soft, small testicles without masses. The lower extremities exhibited non–pitting […]

Case Presentation: A 63–year–old man with diabetes mellitus, end–stage renal disease on hemodialysis, hypertension, aortic stenosis, remote deep venous thrombosis, and anemia presented with 4 days of severe epigastric abdominal pain radiating into the chest with associated nausea and emesis. He also noted 2 months of dysphagia to solids, dyspepsia, reflux symptoms, and eructation with […]

Case Presentation: A 50–year–old Caucasian male, known HIV, off Highly Active Antiretroviral Therapy (HAART) for 7 years, presented to the ED because of weakness. He gave a 2–week history of fever and productive cough, as well as poor appetite and a 50 lb weight loss for the past year. Relevant investigations: White cell count 2.9, […]

Case Presentation: A 65–year–old–man with coronary artery disease, hypertension and hyperlipidemia presented with neck pain and limb weakness. Outpatient medications included furosemide 40 mg daily and potassium chloride 10 mEq daily. Blood pressure was 126/75 mm Hg, pulse 74, and BMI 28. Serum sodium was 138 mEq/L, potassium 3.5 mEq/L, chloride 103 mEq/L, bicarbonate 25 […]

Case Presentation: A 42–year–old female presented to the emergency department complaining of a six day history of left hand swelling, blisters, and itching. Physical exam showed extensive edema and erythema involving the left dorsal hand with scattered tense bulla measuring 1–3 cm involving the first through third digits. There was a loss of sensation to […]

Case Presentation: A 65–year–old Hispanic male presented to the hospital for recurrent episodes of dizziness and diaphoresis over 2 month duration. In the ER, the patient’s blood glucose was 30 mg/dl and his symptoms resolved after 50% dextrose administration. Patient had no significant PMH. Review of systems, physical examination and vitals was normal. The patient […]

Case Presentation: A 63–year–old man developed sudden onset of diffuse abdominal pain associated with nausea and non–bilious vomiting 12 hours after elective percutaneous transluminal coronary angioplasty (PTCA) with drug eluting stent placement in the mid left anterior descending coronary artery. There were no immediate post–procedure complications. Past medical history was significant for hypertension, angina pectoris […]

Case Presentation: Rectus Sheath hematoma (RSH) is an uncommon pathology that arises from rupture of the epigastric arteries which results in accumulation of blood within the rectus sheath. Patients often present as acute abdominal pain often delaying diagnosis. Here we present a unique case of cough induced rectal sheath hematoma. Discussion: A 38 year Caucasian […]

Case Presentation: Estimates indicate that West Nile virus (WNV) infects approximately one and one–half million people in the United States of America. West Nile virus neuroinvasive disease is a very rare presentation, occurring in less than 1% of affected patients infected with WNV. Patients may develop any combination of meningitis, encephalitis, and acute paralysis. We […]