Case Presentation: A 63 year old male with no past medical history was admitted with five months of bilateral upper and lower extremity weakness as well as a pruritic, erythematous rash on his face, arms, and back. This was followed by progressive dysphagia. Initial workup, including a pectoralis muscle biopsy showing necrotizing myopathy, and MRI [...]

Case Presentation: A 76-year-old white woman with a past medical history of RA, being treated with MTX, sarilumab, and folic acid supplementation, presented to the hospital for worsening pain and lethargy. Physical exam displayed dry mucous membranes, ulcerations throughout the oropharynx, and purple digits from distal interphalangeal joints to the fingernails bilaterally. Additionally, she was [...]

Case Presentation: This patient is a 34 year old female presenting to the ED complaining of progressive weakness,SOB, bloody vomitus, and tarry stool. She had PMH significant for established diagnosis of Bean Syndrome. On presentation she was normotensive, 113/72mmHg but tachycardic 102. Labs revealed acute microcytic anemia H/H 6.7/23.6 MVC 70.9 prior to transfusion. She [...]

Case Presentation: This is a 72-year-old female patient who presents to the ED for the evaluation of loss of consciousness. The patient’s family also endorsed dark stools for the past few days. She has a medical history significant for Insulin Dependent Diabetes Mellitus, and papillary thyroid cancer. On arrival, the Patient’s BP was 126/55, Heart [...]

Case Presentation: Patients presenting with melena are often found to have an upper gastrointestinal source: melenic stool on exam has a likelihood ratio of 25 for upper gastrointestinal bleed (1). But what if repeated endoscopies are unimpressive? Mr. S is a 75 year old male with a history of atrial fibrillation on apixaban for three [...]