Background: The opioid epidemic continues to exert a significant impact on our health care system. Patients with intravenous drug use (IVDU) often develop life threating infections leading to prolonged hospitalizations with poor outcomes. Traditionally, the focus of treatment during these hospitalizations is on the infectious complications with very little emphasis on the underlying substance use [...]

Case Presentation: 70-year-old male with remote past medical history of prostate cancer and COPD presented to the emergency department with new onset left side weakness along with left side facial droop. Patient underwent CT scan of the head which was negative and an MRI of the brain which showed multiple bilateral small strokes that raised [...]

Case Presentation: A 45-year-old-man with no prior medical history presented to the emergency department with a symmetric lower extremity rash and recurrent fevers. The rash started two weeks prior as discrete mildly pruritic red lesions on his ankles and spread to his arms, torso and back. He subsequently developed recurrent fevers up to 38.9°C on a [...]

Case Presentation: A 54 year-old-woman presented with one week of progressive fatigue, shortness of breath, and productive cough.  Physical exam revealed fever of 101.6⁰ F, poor oral dentition, bilateral pulmonary crackles and left lower quadrant abdominal tenderness. Initial laboratory workup was remarkable for elevated procalcitonin which prompted initiation of broad spectrum antibiotics. Chest X-ray was [...]

Case Presentation: An 80 y/o Hispanic man with past medical history significant for COPD, ascending aortic aneurysm s/p graft repair 10/06, and recent biventricular pacemaker implantation 4/16 due to third-degree heart block presented with dyspnea, productive cough, orthopnea and fever to 103 F in 5/16. Physical examination revealed III/VI diastolic murmur, bilateral pulmonary rales, peripheral [...]

Case Presentation: Our patient is a 62-year-old Eastern European female with no significant past medical history who was brought to the emergency department after a sustaining a syncopal episode. At the time of exam, she was largely asymptomatic, and her review of systems was positive for a brief isolated episode of mild chest pain that [...]

Case Presentation: 60 y/o African American male with h/o chronic esophageal strictures s/p multiple esophageal dilations presented to the ER with complaints of weakness and dizziness. He met criteria for sepsis with possible source as aspiration pneumonia and was started on broad spectrum antibiotics. Two sets of blood cultures done from admission grew Streptococcus mitis/oralis. [...]

Case Presentation: The patient is a 29 year old woman with a history of intravenous drug abuse, admitted six weeks postpartum for MSSA bacteremia and tricuspid valve endocarditis (4 x 2.5 cm vegetation) complicated by bilateral pulmonary septic emboli with loculated empyema. She was started on nafcillin, which complicated the course with acute interstitial nephritis [...]

Case Presentation: A 47-year-old immunocompetent male with a medical history significant for active intravenous heroin abuse presented to the hospital with fever and respiratory distress. On admission, he was diaphoretic, febrile, and hypoxemic with an oxygen saturation of 70% on ambient air, necessitating intubation and mechanical ventilation. Chest radiography revealed a right lower lobe infiltrate [...]