Case Presentation: A 72-year-old man with a with a history of hypertension, coronary artery disease, and atrial fibrillation on warfarin, not known to have immunosuppressive disease, presented to the ED with a 6 week history of loose, non-bloody bowel movements, intermittent melena associated with urge sensation, incontinence, and tenesmus. He had lost 30 pounds over [...]

Case Presentation: A 66-year-old female with newly diagnosed diabetes mellitus type 1 (DMT1) and hypertension was evaluated for severe hypokalemia on routine labs. Associated symptoms included generalized fatigue, muscle cramps, bilateral lower extremity edema. Physical exam was remarkable for moon face, bibasilar crackles, and lower extremity edema. Initial workup showed sodium of 151 mEq/L, potassium [...]

Case Presentation: An 80-year-old female presented to the emergency department with fever, dyspnea, and constitutional symptoms. She was febrile at 39.8 °C, but was otherwise hemodynamically stable. Laboratory abnormalities consisted of anemia with hemoglobin of 6.9 g/dL (range:12.0-16.0 g/dL) and thrombocytopenia with platelet count of 28 10E3/uL (range:130-400 10E3/uL). Peripheral blood smear revealed intraerythrocytic inclusions [...]

Case Presentation: A 34-year-old male from Puerto Rico with unclear childhood vaccination history came in to emergency room with bilateral facial swelling noted since awakening.  His temperature was 38.1° C with white blood count of 14.2 x10 3/uL and mildly elevated lactate. He was started on broad- spectrum IV antibiotics and maxillofacial CT showed enlargement [...]

Case Presentation: A 78-year-old male from Haiti presented to the emergency department with complaint of headache for one day and intermittent confusion for one month according to family. On presentation, he was alert and oriented to person and place only, he was otherwise neurologically nonfocal. Evaluation included absence of fever, WBC count elevation, pyuria and [...]

Case Presentation: A 20 year-old male presented to a community hospital with multiple days severe post-prandial nausea, vomiting, and abdominal pain. Symptoms were not relieved with pain medications or anti-emetics. The patient underwent esophagogastroduodenoscopy (EGD) showing distal duodenal ulceration suspicious for Crohn’s disease (CD) and biopsies were taken which were reported to be negative. The [...]

Case Presentation: An 84 year old female with history of dementia, atrial fibrillation and papillary thyroid cancer who underwent total thyroidectomy in 2007 was admitted to the hospital for acute on chronic lower abdominal pain secondary to chronic constipation and irritable bowel syndrome. The patient’s medications included Bentyl and Levothyroxine 88 mcg for iatrogenic hypothyroidism. Her constipation workup included measurement of her thyroid stimulating hormone (TSH) level which was low at 0.06 ulU/mL (reference range 0.30-5.00 ulU/mL) and [...]

Case Presentation: A 58-year-old man with a medical history of recurrent acute on chronic pancreatitis due to alcohol use disorder presented with a 3-day history of right-sided pleuritic chest pain and dyspnea. Chest X-ray revealed a new large right-sided pleural effusion.   Analysis of the aspirated serosanguinous exudative pleural fluid yielded a total amylase of 24,600 [...]

Case Presentation: A 59 year-old woman presented with progressive dyspnea for four months. She was previously treated for pneumonia, but her symptoms continued to progress. On review of systems, she denied fevers, night sweats, weight loss, hemoptysis, hematuria, but endorsed intermittent dry cough. Past medical history was significant for hypertension for 5 years treated with hydralazine [...]

Case Presentation: A 90-year-old man with a history of left upper lobe pulmonary nodule on prior imaging presented with dark tarry stools, fatigue and syncope. He had not had an EGD or colonoscopy done in about 10 yrs. Five months prior to this presentation, a 2.4 cm left upper lobe pulmonary nodule suspicious for neoplasm [...]