Case Presentation: A 9-year-old male with 5-day history of headache, fever, somnolence, red eyes and fatigue presented to the ED due to concern for Kawasaki disease. In the ED, frontal headache, fever, photophobia, and neck pain were noted raising concern for meningitis. Screening MRI brain did not demonstrate acute intracranial abnormality, but did show sinus [...]

Case Presentation: A 14-year-old male with history of juvenile ankylosing spondylitis (JAS) and asthma presented to the hospitalist service with four weeks of fever, weight loss, dyspnea, wheezing and cough. He was admitted one week prior for treatment of bilateral pneumonia and was continued on antibiotics after discharge for a ten day course. He had [...]

Case Presentation: A 6-week-old female presented to the emergency room with one day of fever associated with emesis, decreased urine output and fussiness. Initial evaluation included a normal urinalysis, no leukocytosis, mild thrombocytopenia and a mildly elevated procalcitonin. Ultrasound of the pylorus was normal. She was admitted for evaluation of sepsis and started on empiric [...]

Case Presentation: The patient is a 13-year-old female with attention-deficit/hyperactivity disorder (ADHD) and depression who presented following an intentional overdose of her lisdexamfetamine (Vyvanse™). She admitted to taking 15 – 40mg tablets in addition to 5 tablets of an unknown, over the counter sleep aid. She developed dizziness and mild non-radiating substernal chest pressure 10-15 [...]

Case Presentation: A previously healthy sixteen-year old Japanese-American female presented to her primary care provider following one week of frontal headache, dizziness, and a feeling of “floating while walking.” Exam revealed upper extremity blood pressure of 148/93 and a loud bruit across her left lower back. A renal ultrasound ruled out renal artery stenosis, but [...]

Case Presentation: A 9-year-old boy with sickle cell disease (SCD) presented with 5 days of fever and left-sided neck pain. His physical exam was notable for tender cervical lymphadenopathy bilaterally as well as objective fever. Laboratory studies revealed leukopenia, a microcytic anemia, and elevated c-reactive protein. A nasopharyngeal viral PCR panel was negative. An ultrasound [...]

Case Presentation: A 17 year old male recently diagnosed with high risk B-Precursor ALL and induction failure, was found in clinic to have an acute murmur. Three days prior, he had arm and leg aches, dry cough, a single fever and fatigue that improved with blood transfusion. Now he had a 3/6 holosystolic blowing murmur [...]

Case Presentation: A previously healthy 12 month old presented to the emergency department with three weeks of progressively worsening generalized edema and one week of fatigue and pallor. Patient was born at term, and growth and development had been appropriate. Mother had stopped breastfeeding several weeks prior to presentation, just before patient’s first birthday. Patient’s [...]

Case Presentation: A 71-year-old female was transferred from an outside hospital where she was being managed for an AKI following an episode of profuse vomiting and diarrhea. She reported a nine-year history of similar episodes and had received a diagnosis of cyclical vomiting syndrome in the past. She also endorsed 30 lb weight-loss over the [...]

Case Presentation: A 78-year-old African-American male with a history of paroxysmal atrial fibrillation, syncope, hypertension, and heart failure with reduced ejection fraction (HFrEF 30-40%) presented to the emergency department with increased exercise intolerance and shortness of breath. In addition, he reported progressive leg swelling and episodic chest pressure. Vitals were within normal limits (BP 106/71, [...]