Case Presentation: A 60 year old female with past medical history of chronic migraines presents with chief complaint of nausea and vomiting, with associated headache and malaise. She reports recent emergency room visit two weeks prior at an outside hospital for a “cold” with stomach pain. She was told she had a urinary tract infection [...]

Case Presentation: A 42-year-old female presented to the emergency department with a 2-week history of jaundice, intermittent abdominal pain, hip pain, and fevers. Her past medical history was significant for ankylosing spondylitis. She was on chronic immunosuppression with prednisone, Plaquenil and Infliximab. Initial evaluation was remarkable for abnormal liver function and thrombocytopenia (Table 1). The [...]

Case Presentation: A 74-year-old man with coronary artery disease, sick sinus syndrome with biventricular PPM/ICD, HFrEF (EF 45%), and diabetes. He presented to the hospital with five days of worsening substernal chest pain and troponin elevation concerning for a NSTEMI. Urgent left heart catheterization showed multivessel disease and he subsequently underwent three vessel CABG. His [...]

Case Presentation: A 73 year-old man with type 2 diabetes mellitus (hemoglobin A1c 7.5), hypertension, hyperlipidemia, chronic renal failure stage 3a, and a distant 10 pack year smoking history presented with 2 weeks of substernal chest tightness and dyspnea on exertion. He was hemodynamically stable without tachypnea at rest. Examination revealed a grade 2/6 holosystolic [...]

Case Presentation: A 75yo male presented with a few altered mental status. He had been in a rehabilitation facility working on physical therapy with family when he suddenly closed his eyes and became non-responsive. One month ago, the patient had had a fall from a ladder causing a subdural hemorrhage and uncal herniation that required [...]

Case Presentation: A 68 year­-old man with prior Agent Orange exposure in Vietnam presents with 6 months of progressive orthostatic hypotension (OH), syncope, 60 lb weight loss, and lower extremity weakness, parasthesias, and allodynia.Prior workup found mildly elevated troponin and BNP, but a normal stress test. Midodrine had no improvement in OH, and BP on [...]

Case Presentation: A 59-year-old woman with a history of recurrent hospital admissions over several years for neutropenic fever who presented for generalized body weakness and fever of 102F for one day. On presentation the patient had a temperature of 102.9F, HR 106, BP 128/96. Physical exam was notable for tender cervical lymphadenopathy and pharyngeal erythema. [...]

Case Presentation: An 80-year-old man native to the Rio Grande Valley with chronic obstructive pulmonary disease (COPD) and obesity presented with bilateral lower extremity pain and erythema that had been worsening over the last six months. Prior to admission the patient had been diagnosed with bilateral lower extremity cellulitis and completed multiple courses of oral [...]

Case Presentation: 57 y/o Caucasian male with 45 pack year history and 6-weeks history of non-resolving community acquired pneumonia, treated with levofloxacin as an outpatient for 4 weeks, presents with 3 days of worsening cough, malodorous green sputum production, chills, subjective fevers and diaphoresis. He also reported a 20 pounds weight loss and poor appetite [...]

Case Presentation: A 69 year-old Mexican man with a history of polysubstance abuse presented to the hospital for fever and dysphagia of 4 weeks duration. CT of the chest taken at an outside facility showed a large esophageal mass with right hilar and left supraclavicular lymphadenopathy (Figure 1). Given concern for malignancy, an EGD with [...]