Case Presentation: A 33-year-old man presented to the emergency department with sudden onset, severe abdominal pain radiating toward the back. Medical history included bipolar disorder treated with bupropion, sertraline, and lamotrigine. Surgical history included prior appendectomy. There was no history of sick contacts, alcohol use, gallstones, or peptic ulcer disease. On exam he was tachycardic [...]

Case Presentation: A 99-year-old female presented to the emergency department due to new onset, post-prandial abdominal pain, nausea, and vomiting. History was significant for atrial fibrillation (AFib), heart failure with preserved ejection fraction (HFpEF), diabetes, and hypertension. Physical exam was significant for chronic bilateral lower extremity edema without JVD or rales. On admission, her electrocardiogram [...]

Case Presentation: A 33-year-old female with a history of alcohol use and rheumatoid arthritis presented with a 2 day history of sharp, peri-umbilical and left upper quadrant (LUQ) pain. She also reported one month of fevers, night sweats, unintentional 10 Lb weight loss, and a non-productive cough without hemoptysis. She underwent a dental extraction for [...]

Case Presentation: A 24 year old pregnant female at 23 weeks gestation presented with complaints of fevers and fatigue. She was treated symptomatically and discharged home. Two weeks later, the patient developed encephalopathy, profound liver failure, and thrombocytopenia, resulting in induction of labor and loss of the infant. She was subsequently intubated and developed shock [...]

Case Presentation: 67 year old man with a history of psoriasiform dermatitis refractory to dapsone and hydroxychloroquine, thrombotic thrombocytopenic purpura status post plasma exchange and rituximab, and a history of multiple venous thromboemboli, and a fever of unknown origin presented with progressive worsening of his skin lesions. On exam, the patient was febrile (temperature 39.3C), [...]

Case Presentation: A 58-year-old female presented to the ED with one month of generalized worsening weakness, malaise, and diaphoresis. The patient’s medical history included severe Crohn’s disease, osteoporosis, tobacco use, and right kidney atrophy. Initial exam findings included abdominal distension, left upper quadrant tenderness, and anasarca. Labs revealed hemoglobin 8.6, hematocrit 25.0, WBC 10.7, platelet [...]

Case Presentation: Levamisole is an anti-parasitic drug used in the veterinary setting. It is a frequent cocaine contaminant found in about 60-70% of samples in the United States (US) [1]. Cocaine contaminated with this substance is linked to antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis [2]. As in the last decade, cocaine use worldwide has been [...]

Case Presentation: A 52-year-old female with a medical history of chronic sinusitis and recurrent pneumonia secondary to granulomatous disease presents with new onset AKI, worsening fatigue, malaise, weight loss, and transaminitis. She was given Solu-medrol, transitioned to prednisone with improvement. Chest X-ray revealed a patchy airspace opacity in the right middle lobe, concerning for pneumonia [...]

Case Presentation: A 78-year-old female with a history of uterine carcinosarcoma diagnosed two years ago presented to the ED with a primary complaint of orbital swelling, blurry vision, and diplopia OS. One week prior, she received her 5th and 1st cycle of Pembrolizumab and Zometa infusion, respectively for her uterine carcinosarcoma. Three days status post, [...]

Case Presentation: Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy, with high propensity to metastasize and reoccur. It most commonly affects the skin, and seldomly involves internal organs [1]. MCC is a rare entity, with 2488 cases/year in 2013 in the United states and more aggressive than melanoma [1, 2]. Gaining insight into this [...]