Case Presentation: A 19 year old female with a history of systemic lupus was found at home unresponsive by family and brought to a local ED. At the ED she was hyperthermic to 106F and hypotensive then transferred to Vidant Medical Center fevers and septic shock. Of note she had recently been discharged from Duke [...]

Case Presentation: A 54 year-old Hispanic man with a history of deep vein thrombosis (DVT) and glioblastoma multiforme treated with right parietal craniotomy and temozolomide, presented with fever, headache, and odynophagia. He reported a week of odynophagia with solids and liquids, worsening headaches, and fever of 100.4 F. His last cycle of temozolomide and radiation [...]

Case Presentation: 64-year-old man with history of schizoaffective disorder, hypertension, cigarette smoker (quit recently) was admitted to the hospital with acute onset recurrent falls in the last 2 weeks. Medications include buspirone 10mg, amlodipine 2.5 mg, metoprolol 50 mg, clozapine 450 mg. He had hypotension on presentation, which improved with fluids. Symptomatic orthostatic hypotension persisted [...]

Case Presentation: A 40-year-old Caucasian woman with history of surgically-repaired lumbar spinal stenosis presented with a progressive swollen and painful right foot over past few hours. The patient was concerned of a spider bite though did not see a spider. The dorsal aspect of the foot was erythematous, edematous, with a pinpoint area of necrosis [...]

Case Presentation: A 62-year-old man with type 2 diabetes was hospitalized with a two-week history of fatigue, sore throat, diarrhea, and 18-pound weight loss. In the ED, he was hypotensive and tachycardic, which improved with IV fluids. Physical exam was significant for bilateral posterior cervical lymphadenopathy and splenomegaly. Labs showed leukocytosis (25.8K) with 18.2% lymphocytic [...]

Case Presentation: A 39-year-old man with no significant past medical history was hospitalized with a 2-week history of constant burning left upper quadrant pain, headaches, myalgias, and fever/chills. The patient reported camping in Pennsylvania 1 month prior to presentation. In the ED, he was initially found to be febrile to 102.4F and hypotensive to SBP [...]

Case Presentation: A 64-year-old Middle-Eastern man with a history of rheumatic heart disease status post mechanical mitral Starr-Edwards ball-in-cage valve (in 1968), atrial flutter on coumadin and prior ischemic stroke with residual blindness presented with 4 days of “bloody” urine. Physical exam was significant for scleral icterus, an unchanged holosystolic murmur, and the observation of [...]

Case Presentation: A 63-year-old man was admitted to the hospital medicine service at a quaternary center for painful oral lesions that appeared 6 months prior. The lesions had started as multifocal soreness in the mouth floor 2 weeks after having undergone dental work. He was then evaluated by local oral surgery team who performed biopsies [...]

Case Presentation: A 76 year old male with a history of hypertension and hyperlipidemia presented with acute onset ascending weakness, perioral tingling, and loss of temperature sensation. The patient’s profound weakness progressed over the course of a few days, with subsequent diplopia, hallucinations, and confusion. He received the influenza vaccine a few weeks prior, and [...]

Case Presentation: A 29 year old male presented with four months of painful swelling in his hands, ankles, and feet, along with night sweats and fevers. Work-up revealed mild elevations in ESR and CRP along with normal RF and anti-CCP antibodies. He was diagnosed with seronegative rheumatoid arthritis and started on hydroxychloroquine and prednisone. The [...]