Case Presentation: Syphilis manifestations are widespread, varying with stage and type of visceral involvement. Our detailed understanding of its natural history comes from the pre-antibiotic era and sources like the Tuskegee study. Herein we present a case of complete heart block in a patient with aortic dilation who was subsequently diagnosed to have neurosyphilis during […]

Case Presentation: A 37 year old man with history of alcohol abuse presented to the emergency department for a one month history of jaundice, nausea, vomiting and weight loss. Physical exam was significant for mild diffuse abdominal tenderness and jaundice. Labs were remarkable for a total bilirubin of 34.1, direct 17.5, alkaline phosphatase of 203, […]

Case Presentation: A 21-year-old female with a history of remitting-relapsing MS, and primary adrenal insufficiency presented with fever of three days duration, followed by acute chest pain, and shortness of breath. The patient had been started on her second cycle of alemtuzumab infusion two days prior to presentation. Initial blood work was remarkable for leukocytosis. […]

Case Presentation: A morbidly obese 61-year-old man with coronary artery disease presented for evaluation of exertional dyspnea. No chest pain was reported. Transthoracic echocardiogram and pulmonary function tests were normal, but his dyspnea persisted. Lifestyle modifications and inhaler trials failed to improve his dyspnea. Left and right coronary angiography were completed. A 90% stenosis of […]

Case Presentation: A 54-year-old morbid obese female presented to the hospital with sudden-onset heart palpitations and skin paresthesia a few hours after taking a new medication she was prescribed for weight loss, bupropion/naltrexone 180/16mg once daily. The patient had a history of anxiety, for which she was prescribed citalopram 40 mg once daily. Upon her […]

Case Presentation: 51 year old female with past medical history notable only for recent knee pain with intermittent NSAID use presented with melenic stools and one episode of coffee ground emesis.On presentation she was tachycardic and hypotensive with initial hemoglobin of 4.9 (units) with improvement in vital signs post blood transfusion. Initial CT abdomen/pelvis without […]

Case Presentation: A 37 y/o woman with past medical history of Multiple Sclerosis, diagnosed in 2011 was seen in clinic for evaluation of a new rash. Patient reported 1 week history of a reddish-purplish, non tender rash which had a circular, lacy pattern. She noted that the rash was predominantly in her lower extremities. She […]

Case Presentation: An 84-year-old female with history of pediatric paralytic polio, heart failure with preserved EF, atrial fibrillation, coronary artery disease presented with progressive shortness of breath (SOB). Four months prior, she had presented to the emergency department with similar SOB and generalized weakness. At that time EKG, CT angiography chest and transthoracic echocardiogram were […]

Case Presentation: A 56-year-old female presented to the ED complaining of epigastric abdominal pain for 5 days. Her past medical history was pertinent for a prior left upper extremity DVT. Her family history was positive for Factor V Leiden deficiency, for which she previously tested negative. She denied any pain radiation, nausea, vomiting, or change […]

Case Presentation: A 37-year old male with PMH of HIV on HAART presented with episodes of seizure, syncope and altered mental status. Vital signs and physical examination were unremarkable. Laboratory results revealed sodium level 113, serum osmolarity 243, urine osmolarity 429 and urine sodium 113. Lab findings along with patient appearing euvolemic on exam suggested […]