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HEPATIC HYDROTHORAX IN A PATIENT WITH MINIMAL ASCITES

SHM Converge 2026

Case Presentation: A 62-year-old with End Stage Liver Disease (ESLD) secondary to autoimmune hepatitis presented with 2 days of dyspnea and cough. In the ED, vital signs were notable for tachypnea and mild hypoxia. Labs revealed an elevated B-type natriuretic peptide of 123. Physical exam demonstrated crackles at the right lung base and bilateral lower [...]

HYPERAMMONEMIA IN A PATIENT WITH UNDIAGNOSED CELIAC DISEASE AND CARNITINE DEFICIENCY

SHM Converge 2026

Case Presentation: This is a case of a 38-year-old female with a relevant past medical history of rheumatoid arthritis who presented with nausea, vomiting, and altered mental status. She was found to have partially compensated anion gap metabolic acidosis and tonic-clonic seizures requiring intubation. Pertinent diagnostic workup revealed a significantly elevated ammonia level of 245 [...]

IMMUNE CHECKPOINT INHIBITORS: A DOUBLE-EDGED SWORD: A CASE OF MULTI-ORGAN IMMUNE-RELATED ADVERSE EVENT

SHM Converge 2026

Case Presentation: A 78-year-old man with newly diagnosed stage IV urothelial carcinoma, recently started on enfortumab vedotin and pembrolizumab, presented with several days of progressive lower-extremity weakness, difficulty rising from a seated position, and blurry vision. Days earlier, he had presented to another facility, where labs showed a troponin of 3,009 ng/L with a normal [...]

IMMUNE MEDIATED NECROTIZING MYOPATHY: A RARE STATIN-RELATED COMPLICATION

SHM Converge 2026

Case Presentation: A 65-year old woman taking a stable dose of high-intensity rosuvastatin presenting with 3 weeks of proximal extremity weakness and pain, noted to have an elevated creatinine kinase (CK) on presentation (7,459 U/L). Despite discontinuation of rosuvastatin and standard rhabdomyolysis management, CK levels failed to normalize, and patient continued noting persistent proximal muscle [...]

IMMUNODEFICIENCY EXPOSED: HOW A CASE OF DISSEMINATED NOCARDIOSIS WITH CNS INVOLVEMENT UNRAVELED A HIDDEN DIAGNOSIS

SHM Converge 2026

Case Presentation: A 41-year-old previously healthy man presented with three weeks of cough and one week of progressive headache, fever, confusion, and weakness. He is currently a construction worker who was born in Guatemala but has lived in Southern California since 2001. Initial vital signs were notable for a fever of 102.7 F, pulse 134, [...]

JEHOVAH’S WITNESSES TREATMENT CONSIDERATIONS: ALL BLOOD DERIVED PRODUCTS MAY NOT BE REJECTED

SHM Converge 2026

Case Presentation: 42-year-old Jehovah’s Witness female with history of uterine fibroids, PCOS, anxiety who initially presented to the emergency department with new small spots on her arms and legs found to have a platelet count of 2x 10E3/uL. She was diagnosed with ITP at the time she was hemodynamically stable and agreed to close follow-up [...]

LOWER EXTREMITY GIANT BASAL CELL CARCINOMA MASQUERADING AS PYODERMA GANGRENOSUM

SHM Converge 2026

Case Presentation: The patient is a 62-year-old female with a history of a chronic right lower extremity wound and tobacco use disorder who presented to the emergency department for increased discharge from her chronic wound. She states the wound started as a small laceration and has slowly progressed in size for 15 years; she has [...]

PJP IN HEALTHY PATIENT LEADING TO HLH

SHM Converge 2026

Case Presentation: 50 year old male with PMH significant for seizure disorder (on Keppra) and COPD (not on home oxygen) presenting with weakness, fatigue, dyspnea on exertion, and 50-pound weight loss over four months. During this admission, he was found to have acute hypoxic respiratory failure secondary to right basilar pneumonia with small right pleural [...]

PRIMARY CNS VASCULITIS: DIAGNOSTIC CHALLENGES AND INSIGHTS

SHM Converge 2026

Case Presentation: A 51-year-old woman presented to the ER with acute altered mental status, left-sided weakness, and fever. Her medical history includes hypertension, hyperlipidemia, complex migraines, and strokes (2021, 2024). A stroke code was activated. Vital signs showed fever 40.6°C, HR 120, and BP 180/100 mmHg. Labs showed leukocytosis and lactic acidosis. Physical exam revealed [...]

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REFRACTORY SEIZURES AS A MANIFESTATION OF ANTI-EPILEPTIC DRUG INDUCED HYPOCALCEMIA AND VITAMIN D DEFICIENCY

SHM Converge 2026

Case Presentation: A 34-year-old female with a history of focal epilepsy diagnosed during childhood complicated by status epilepticus, anxiety, depression, ADHD, and history of chronic hyponatremia presented to the hospital at 25 weeks gestation with complaints of recurrent seizures. During the admission process she had multiple witnessed generalized tonic-clonic seizures with nystagmus requiring multiple rounds [...]

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