Case Presentation: A 51-year-old female with a history of lumbar stenosis (status post-transforaminal epidural steroid injection), hypertension, and migraines presented with altered mental status and severe acute headache. The day before, she experienced unusual lower back pain and, after consuming shrimp scampi, developed abdominal pain, nausea, flaccidity in her upper extremities, dysarthria, and a severe [...]

Case Presentation: This case report outlines the case of a 76 year-old male who presented with bacterial meningitis secondary to an infected intrathecal baclofen pump, but initial lumbar puncture cerebrospinal fluid (CSF) did not demonstrate pleocytosis. Patient endorsed worsening headache, vomiting, and bilateral lower extremity weakness 6 days prior to admission. He was immediately started [...]

Case Presentation: A 53-year-old female with chronic small fiber polyneuropathy and erythromelalgia presented with severe headaches, nausea, vomiting, diarrhea, body aches, photophobia, and neck stiffness for two days. Symptoms started one week after receiving intravenous immunoglobulin (IVIG) for an erythromelalgia flare. On presentation to the ER, she was afebrile and physical examination was unremarkable. Respiratory [...]

Case Presentation: Many patients are being treated with biologic therapies for autoimmune diseases in the outpatient setting. It is critical for the hospitalist to recognize these patients as immunosuppressed and generate a broad differential when they are admitted to the hospital. The patient in this case was a 35-year-old male with a past medical history [...]

Case Presentation: The patient, a 29-year-old G1P1 female, presented to the emergency department with a 3-day history of double vision, frontal headache, and gait instability. Eye examination was significant for asymmetric bilateral internuclear ophthalmoplegia. Admission labs demonstrated mild leukocytosis without left shift and elevated inflammatory markers including complement levels and IL-6. An MRI of the [...]

Case Presentation: A 27-year-old woman with no significant medical history presented with a two-month history of headache, neck stiffness, nausea, vomiting, photophobia, back pain, and fever. Two months prior, she underwent liposuction and a Brazilian Butt Lift. Examination showed nuchal rigidity and lumbar tenderness. Labs revealed elevated ESR (24 mm/hr) and CRP (31.9 mg/dL), with [...]

Case Presentation: A 53-year-old female elementary school teacher with a history of genital herpes and aseptic viral meningitis presented with two days of severe headache, neck stiffness, fever, nausea, vomiting, bilateral leg weakness and back pain. Her headache was sudden, severe (10/10) and diffuse, progressed to neck stiffness and was associated with photophobia, fever, chills [...]

Case Presentation: A 31-year-old healthy man presented with several days of chest and back pain associated with shortness of breath, subjective fever, headache, and photophobia. The patient worked in construction and complained of a recent itchy, vesicular rash to his forearm. Review of systems was otherwise negative for recent procedures or surgeries, IV drug use, [...]

Case Presentation: A 45-year-old female presented with fever, chills, bilateral flank pain radiating anteriorly and intermittent right upper quadrant pain prior to arrival. Medical history included hypertension, stage 3a chronic kidney disease, obesity, uterine fibroids, and treated Helicobacter pylori infection. Her vitals were as follows: 98.6 °F, heart rate 126 beats/minute, respiratory rate 20 breaths/minute, [...]

Case Presentation: West Nile Virus (WNV) was first reported in the Western Hemisphere in New York City in 1999. Over the last two decades West Nile Virus has spread to an impressive distribution from central Canada to Southern Argentina. Transmission of the virus is maintained in a cycle between Culex species mosquitos and birds as [...]