Case Presentation: A 26 year old female with a history of morbid obesity status post lap band procedure presented with fevers, bloating, nausea and vomiting for 1 month. CT Abd/Pelvis w/o contrast demonstrated marked ascites intra-abdominally and in the pelvic cavity. Chlamydia/Gonorrhea assays were performed and returned negative. She then had a paracentesis with fluid [...]

Case Presentation: A 72 year old man with esophageal adenocarcinoma presented with five days of progressive exertional dyspnea and a “grabbing” sensation in his chest. He had started FOLFOX two weeks prior to presentation for newly diagnosed metastases. The patient’s exam was notable only for tachycardia and conjunctival pallor. Laboratory studies revealed a new anemia [...]

Case Presentation: A 54-year-old male was diagnosed with left renal pelvic, caliceal and ureteral transitional cell carcinoma(CA) 3 years before presentation. Patient had a history of transitional cell CA of the bladder that had extended to both kidneys despite local intervention. Patient underwent left sided nephroureterectomy 2 years later because of massive disease burden. Renal function [...]

Case Presentation: A 67 year old African American man with extensive stage small cell neuroendocrine lung cancer presented to the ED with one month of shortness of breath. On exam, he was in mild distress requiring 2L nasal cannula (NC). RR 23-37. CXR revealed a large right pleural effusion. A thoracentesis confirmed the effusion to [...]

Case Presentation: The patient is a 42 year old male with HIV (CD4 116, VL 33K) with poor adherence to antiretroviral therapy who presented to clinic with 3-6 months of anorexia and one week of cough and fevers. He was febrile to 39.4C, started on treatment for pneumonia, and admitted to the hospital. Imaging showed [...]

Case Presentation: An 88 year old female with no past medical history presented to the ED with low back pain, chronic cough and one episode of pinkish sputum.  Chest CT showed bilateral nodular lesions. Serological tests including ANCA were sent before her discharged home. Next day, she returned with acute right lower extremity weakness and [...]

Case Presentation: A 70-year-old healthy active male with past medical history of Hypertension and tobacco use 1 pack per day, presented with flushing, weakness, pre-syncope, skin hives, diarrhea, shortness of breath and unintentional 20 pounds loss.  Recently returned from a trip to Cuba and his PCP performed blood work and stool studies , significant for [...]

Case Presentation: The patient is a 29 year old woman with a history of intravenous drug abuse, admitted six weeks postpartum for MSSA bacteremia and tricuspid valve endocarditis (4 x 2.5 cm vegetation) complicated by bilateral pulmonary septic emboli with loculated empyema. She was started on nafcillin, which complicated the course with acute interstitial nephritis [...]

Case Presentation: The patient is a 61-year-old, Native American female with history of bioprosthetic mitral valve, presenting with increased dyspnea, cough, diarrhea, and fever for two weeks. Ceftriaxone and azithromycin were started for right middle lobe infiltrate seen on chest X-ray and suspected pneumonia.  Initial physical examination revealed a new prominent murmur and blood cultures [...]

Case Presentation: A 69 year old man presented with a two week history of high fevers and malaise after a spider bite behind his knee two weeks prior to admission. He also reported nausea, diarrhea, and crippling fatigue. His primary care doctor prescribed a course of amoxicillin-clavulanate but this had not helped. He lived in [...]