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 [...]

Case Presentation: A 40-year-old female presented in June of 2023 with emesis and a fever of 38.9 °C. She complained of epigastric pain radiating to the back. The patient reported no recent travel. She worked in a daycare and had a pet dog. She had not hiked or camped recently. She walked her dog at [...]

Case Presentation: 21-year-old female presented with three weeks of progressive right-sided chest pain, shortness of breath, and fatigue. Her symptoms began shortly after a three-hour car ride. She had a history of a second-trimester miscarriage four months earlier, complicated by acute blood loss anemia requiring transfusion. She briefly used oral contraceptives following the miscarriage. She [...]

Case Presentation: A 35-year-old woman with end-stage renal disease (ESRD) on chronic hemodialysis, suspected drug-induced lupus with recurrent pericarditis, and severe bi-valvular disease requiring bioprosthetic aortic valve replacement seven months earlier, presented with progressive exertional dyspnea, early satiety, and worsening left upper quadrant abdominal pain initially thought to be a lupus flare. Laboratory evaluation was [...]

Case Presentation: A 48-year-old female with a history of cyclic vomiting syndrome, gastroparesis, postural orthostatic tachycardia syndrome (POTS), opioid dependence, and a right-sided Port-A-Cath presented with two days of generalized weakness, a witnessed seizure-like episode, and a fall. Initial trauma evaluation was unremarkable. Laboratory studies revealed leukocytosis (WBC 20.8), thrombocytosis (platelets 648), mild hyponatremia (Na [...]

Case Presentation: A 79 year old female with a past medical history of type 2 diabetes mellitus, hypertension, coronary artery disease, and prior ischemic stroke presented with a three day history of weakness and confusion. She was oriented to self and location at baseline, without a diagnosis of dementia. Initial investigation revealed an urinalysis with [...]

Case Presentation: A 72-year-old male with lung adenocarcinoma in PET-confirmed remission developed rapidly progressive, symmetric inflammatory polyarthritis five months after completing immune checkpoint inhibitor (ICI) therapy with pembrolizumab. He reported diffuse joint pain, morning stiffness, fatigue, and functional decline involving multiple large and small joints. Examination revealed bilateral wrist and metacarpophalangeal synovitis, restricted wrist motion, [...]

Case Presentation: A 48-year-old man with alcohol use disorder presented with midsternal chest pain and progressive bilateral leg weakness following diarrhea and upper respiratory symptoms. Examination showed proximal weakness without sensory loss. Imaging and labs were unremarkable. Suspecting acute inflammatory demyelinating polyneuropathy (AIDP), IVIG was initiated after lumbar puncture; MRI spine was normal.Within 24 hours, [...]

Background: Undocumented immigrants comprise an estimated 3% of the US population. In many regions, this population is ineligible for public insurance programs like Medicaid and Medicare and typically receive coverage only for emergency services. In addition to lacking health insurance, many face barriers such as poverty, food insecurity, homelessness, unemployment, illiteracy, stigmatization, and fear of [...]

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 [...]