Case Presentation: A 47-year-old woman with a history of alcohol abuse presented to the emergency department with one week of altered mental status. Review of systems was significant for involuntarily 100 lbs. weight loss over one year with no change in appetite.  She reported no prescribed or over-the-counter medication use. Vital signs on presentation were [...]

Case Presentation: A 55 year-old male with a history of anxiety presented with bilateral limb tremor associated with transient loss-of-consciousness. The seizure was attributed to benzodiazepine withdrawal and he was discharged on levetiracetam. He subsequently developed speech impairment, sleep disturbance, agitation and hallucinations which prompted re-admission. CSF analysis showed a monocytic pleocytosis.  EEG revealed epileptiform [...]

Case Presentation: A 68-year-old male with neurogenic bladder requiring self-catheterization, atrial fibrillation on coumadin, and osteoarthritis on chronic ibuprofen presented with lower extremity weakness after a fall. He was found to have a supratherapeutic INR of 6.6 and temperature of 39°C. Laboratory work showed leukocytosis to 15.5 th/mm3 and urinalysis with 3+ leukocyte esterase and [...]

Case Presentation: A 60-year old female with past medical history significant for diabetes, hypertension, and hypothyroidism presented with acute onset confusion progressing over the course of 5 hours. On exam, patient’s vitals were significant for an elevated blood pressure (179/104). She was only oriented to herself and showed no focal motor deficits, but did have [...]

Case Presentation: The patient is a 62-year-old Bangladeshi male with Non-alcoholic Steatohepatitis (NASH) related cirrhosis, sarcoidosis, and poorly controlled type II diabetes who presented with one week of chest pain and five days of cough. The chest pain was non-exertional, pleuritic and localized to the left lateral chest wall. The cough was productive of scant [...]

Case Presentation: A 58- year-old female presented with vomiting, dizziness, and a blood pressure of 80/60 mmHg. Laboratory: serum creatinine 3.1 mg/dl (baseline 1 mg/dl), BUN 34 mg/dl (baseline 10 mg/dl), corrected calcium 12.3 mg/dl, low PTH , normal 25-OH vitamin D, and normal PTH-related protein. Two months prior, serum calcium was normal and 25-OH [...]

Case Presentation: A 33-year-old-female presented with progressive exertional dyspnea and bilateral lower extremity edema for 1 week associated with orthopnea, palpitation & fatigue. She also had 3 kilograms of weight loss in 2 months with normal appetite. She was anxious, looked very pale and in mild respiratory distress. Pulse was 113 /min regular, temperature 37.9 [...]

Case Presentation: A 30-year-old previously healthy man presented with one week of fatigue, malaise, and confusion, complaining of dull neck pain. In the ED he became acutely agitated and combative, eventually requiring sedation and intubation for altered mental status. Initial vitals were normal, with BP 130/85 and HR 66, but then patient developed a fever [...]

Case Presentation: A 76-year-old woman with history of non-small cell lung cancer status post chemoradiation five years ago presented with acute onset of diffuse muscle weakness and swelling in bilateral forearms and legs, with a “woody” texture on palpation but without fluctuance. BP and HR were normal, but she had recurrent fevers as high as [...]

Case Presentation: A 31-year old woman with a history of bipolar disorder presented to the hospital with generalized coarse tremors of the extremities for 2 weeks duration following initiation of lithium for hypomanic episode. Initial vital signs were T 39 °C, HR 103 bpm, BP 98/59 mmHg, RR 16, and O2 saturation 100% on room air. [...]