Background: Nocardiosis is a rare but potentially severe infection that can affect the immunocompromised as well as the immunocompetent population. It presents as a localized or disseminated infection, most commonly introduced through the respiratory trac. A significant amount of time is often needed to establish a diagnosis of nocardiosis, which has been reported to be [...]

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: 35-year-old Caucasian gentleman who was diagnosed with alpha-1 antitrypsin deficiency (PiZZ) 2 years ago. Two weeks prior to the hospitalization, he noticed skin nodules on both sides of the abdominal wall and in the upper thighs. He also noticed a lesion that looked like a boil on his right shin, started draining and [...]

Case Presentation: A 34 year old male with a history of CVID subclass 2 and 4, with low IgG level, absent IgA, liver nodular regenerative hyperplasia with portal hypertension, and immune thrombocytopenic purpura status post splenectomy presented with a month of nonproductive cough, mild episodes of hemoptysis, and shortness of breath. Physical exam revealed peripheral [...]

Case Presentation: A 39-year old female with a history of alcohol abuse presented with an eight-day history of numbness involving her bilateral lower extremities and hands which had progressed proximally to involve her chest wall. She reported perioral and perianal numbness, lethargy and difficulty ambulating. Examination was significant for decreased sensation in a glove-stocking distribution, [...]

Case Presentation: 60-year-old woman with a twelve-year history of presumed gastroparesis of unclear etiology, was admitted for worsening chronic abdominal pain, nausea and vomiting with unintentional weight loss of over 80 pounds over a year. Evaluation included normal laboratory findings and abdominal imaging. Upper endoscopy showed mild mucosal erythema with normal biopsies of the stomach. [...]

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: 59 yo Caucasian male presented from an outside hospital (OSH) with primary complaint of “leg abscesses” of 1 wk duration. Patient was afebrile, vital signs stable and in no acute distress complaining of painful “leg abscesses.” PMHx significant for recurrent scrotal cellulitis for the past few years, but was improving when the leg [...]

Case Presentation: A 24 year old Afro-Caribbean woman with no medical history presented with intermittent facial swelling of one month, several months of fatigue, anorexia and unintentional weight loss of 65 pounds. The swelling initially involved the lower face with gradual spread to bilateral peri-orbital areas. There was no urticaria, rash, dysphagia, dyspnea or visual [...]

Case Presentation: A 79-year-old male presented to the emergency department after a witnessed episode of unresponsiveness, jerking motions, urinary incontinence and post-ictal confusion. The patient’s wife denied a history of epilepsy but reported several months of progressive dysarthria and gait ataxia, for which he had been evaluated nine months earlier. Work-up was negative for hemorrhage, [...]