Case Presentation: A 23 month old female with minimal primary care visits presented to the ED after a syncopal episode. She was found to be tachycardic, tachypneic, and hypoxic. Physical exam revealed an irritable, pale child with a 3/6 systolic murmur and hepatomegaly. CBC was significant for a Hgb of 1.5. CXR revealed cardiomegaly. Due [...]

Case Presentation: An 84 year old female with a past medical history significant for systemic lupus erythematous (SLE) presented to the emergency department with fatigue and dizziness. She had recently been admitted to the same hospital with acute kidney injury secondary to lupus nephritis. During that admission, she was started on high dose prednisone, a [...]

Case Presentation: A 32 year old Caucasian female with a fourteen year history of relapsing-remitting MS was admitted to the hospital for evaluation of severe headache, fatigue and dizziness. On physical exam she was tachycardic and very pale. Pertinent labs were as follows: hemoglobin (Hb) 4.1 mg/dL (baseline Hb 10.5 mg/dL), red cell distribution width [...]

Case Presentation: 44 year old male with insulin dependent type 2 Diabetes mellitus and hypothyroidism presented with fatigue, weakness, dyspnea on exertion and light headedness for several weeks. He denied bloody stools or melena. Medications included metformin for the last 3 months, levothyroxine, simvastatin, enalapril and detemir insulin. The patient was adherent to his medical [...]

Case Presentation: The patient is a 29-year-old female with the history of acute pancreatitis and gastric bypass surgery, who initially presented with lower extremity swelling in the setting of hypoalbuminemia and protein-calorie malnutrition. She was started on high calorie/protein diet and was discharged on furosemide. Three weeks after discharge, she noticed peri-oral rash, which extended [...]

Case Presentation: 58 year old African-American female child-care worker with history of GERD presented with symptomatic anemia. She was in her usual state of health until ten days prior to presentation, when she had several days of GI illness consisting of abdominal pain and diarrhea. Her symptoms self-resolved, only with residual mild epigastric abdominal pain. [...]

Case Presentation: A 46-year-old female presented for evaluation of two days of nausea and vomiting. She also described swelling in her legs and decreased urination over that time. Exam revealed blood pressure of 150/100 (baseline blood pressure 90/50), pitting lower extremity edema, taut skin of both hands, and bibasilar crackles. Labs revealed creatinine of 3.2 [...]

Case Presentation: A 49-year old man with no significant medical history presented with dyspnea and presyncope. He presented similarly six weeks prior and was diagnosed with constrictive pericarditis thought to be of a viral etiology. He had reported an eighteen-kilogram weight loss, intermittent fevers, and night sweats, but, given clinical improvement, was discharged on ibuprofen [...]

Case Presentation: A 43-year-old woman with controlled hypothyroidism presented to her primary care physician for evaluation of one-month of progressive fatigue, dizziness, and “disconnected” feeling. She noted decreased appetite leading to a twenty-pound weight loss. Following a benign physical examination, lab work demonstrated a striking macrocytic anemia with hemoglobin at 5.7 g/dL and mean corpuscular [...]

Case Presentation: A 70-year-old male who presented to us with worsening dyspnea on exertion and non-productive cough. Review of systems was negative. Vitals were unremarkable; physical examination was significant for bilateral basilar rales which were corroborated by his chest x-ray that revealed bilateral pleural effusions. Laboratory findings were notable for normocytic anemia and elevated liver [...]