Case Presentation: 33 year old male with a history of antiphospholipid antibody syndrome (APS), multiple venous thromboembolisms (VTE) on Coumadin, presented with epigastric pain and nausea. Exam was notable for tachycardia, hypertension with pallor, icterus and tender epigastrium. Laboratory studies revealed leukocytosis of 18.6, normocytic anemia, thrombocytopenia (20,000), isolated elevated total bilirubin and INR of […]

Case Presentation: A 68 year­-old man with prior Agent Orange exposure in Vietnam presents with 6 months of progressive orthostatic hypotension (OH), syncope, 60 lb weight loss, and lower extremity weakness, parasthesias, and allodynia.Prior workup found mildly elevated troponin and BNP, but a normal stress test. Midodrine had no improvement in OH, and BP on […]

Case Presentation: A 82 year old Caucasian male with history of long standing well controlled diabetes mellitus type 2 since 2010, gastroparesis, and GERD presented to the ED with 2 episodes of “dark, tarry” stools for 1 day onset with resolution. On review of systems, the patient endorsed 32 pound weight loss over 6 months, […]

Case Presentation: A forty‐three year‐old woman presented with three days of progressive dyspnea and chest pain. The chest pain was band‐like, constant, non‐pleuritic, non‐positional and unrelieved by pain medications. The dyspnea initially was with exertion but now also at rest. She denied leg pain or swelling, fevers, or cough. Her past medical history included rheumatoid […]

Case Presentation: A 64 year-old woman with no significant past medical history presented with nausea, vomiting, 50 lb. weight loss and generalized weakness for the past 6 months. Her primary care physician had prescribed treatment for possible reflux; symptoms did not improve. Three months prior, the patient was admitted to a community hospital where CT […]

Case Presentation: A 27‐year‐old woman with reported sickle‐cell disease, protein C deficiency, pulmonary embolism (PE), and recent methicillin‐resistant Staphylococcus aureus (MRSA) bacteremia was admitted for sickle cell crisis. She was flying between the east and west coast to visit family when she experienced chest pain 45 minutes into the flight. It was sharp, 7/10 in […]

Case Presentation: A 27 year-old African-American woman presented with an episode of hematemesis in the setting of three months of mild intermittent abdominal pain. She also noted an episode of melena, as well as fevers, arthralgias, fatigue and progressive weight loss. Her epigastrium was tender without guarding, and she had diffuse lymphadenopathy and a maculopapular […]

Case Presentation: Patient is a 76 year-old male with a significant background of ischemic heart disease with reduced ejection fraction, pyloric and duodenal ulcers, and chronic kidney disease attributed to chronic glomerulonephritis (not biopsy-proven). He presented with hematemesis and melena. Esophagogastroduodenoscopy revealed multiple gastric ulcers that were negative for Helicobacter pylori. Histology from the gastric […]

Case Presentation: A 65 year-old man with a past medical history of CAD s/p CABG, ischemic cardiomyopathy with EF 35%, bicuspid aortic valve stenosis s/p aortic valve replacement, and asbestosis presented to the ER for evaluation of anterior neck swelling, dyspnea on exertion, dysphagia, and a 30 lb unintentional weight loss over 5 months. On […]

Case Presentation: A 37 year-old right-handed man presented to the emergency department with sudden onset of painless right upper extremity swelling and discoloration following an intense weight lifting session. His past medical history was significant for papillary thyroid carcinoma diagnosed two years earlier and thyroidectomy. He recently began an exercise program including upper arm weight […]