Background: Renal dysfunction is a complication in patients with decompensated cirrhosis. Due to the potential morbidity and mortality of these disorders in cirrhotic patients, it is important to ensure accurate clinical measurements of renal function. Standard creatinine-based estimated glomerular filtration rate (eGFR) equations have proven to be inaccurate in cirrhotic patients, as these patients have […]

Background: Atrial fibrillation (AF), the most common arrhythmia encountered in clinical practice, is managed by a variety of specialists. Current guidelines differ in their recommendations and may not adequately address management in the acute setting, leading to uncertainty regarding important clinical decisions. We sought to document practice pattern variation among cardiologists, emergency medicine physicians (EMs), […]

Background: Spontaneous bacterial peritonitis (SBP) is a commonly encountered complication of end stage liver disease that carries a high morbidity and mortality. Risk factors for SBP are defined by the American Association for the Study of Liver Diseases (AASLD) as a prior history of SBP, active gastrointestinal bleeding, and low ascites total protein (< 1.5 […]

Case Presentation: A 58‐year‐old African American man presented to our hospital with confusion, diffuse morbiliform rash, facial edema, fever to 41.1°C, leukocytosis with eosinophilia, acute kidney injury, transaminitis, and elevated creatinine kinase. Extensive evaluation for possible infection, including urine, blood, and CSF cultures, was negative. Six weeks prior to admission the patient had been started […]

Case Presentation: A 22 year old African American male, with no significant past medical history, presented to the Emergency Room with fever, chills and productive cough of 2 weeks duration. A diagnosis of left upper lobe pneumonia was made at an outpatient visit 1 week ago for which a 5 days course of oral azithromycin […]

Case Presentation: A 53-year-old woman with a history of metabolic syndrome and necrotizing pancreatitis presented with new onset ascites. Her story began nine months earlier, when she developed abdominal pain. CT at that time revealed pancreatitis and cholelithiasis without biliary dilation. Lab values were notable for: lipase 55000, total bilirubin (TBIL) 5.3, AST 660, ALT […]

Case Presentation: A 76-year-old Chinese woman with history of cryptogenic cirrhosis (MELD-Na 25) presented to our hospital with 1 week of worsening jaundice, abdominal distension, and right upper quadrant pain. Cirrhosis was diagnosed by imaging on admission 2 months previously and presumed to be secondary to Hepatitis C infection due to antibody positivity. CT of […]

Case Presentation: A 42 y/o Hispanic female with a history of IV drug abuse and dermatitis since 2005 with recurrent episodes of cellulitis presented to the hospital with severe edema, erythema and pain of the right lower extremity for 3 days. She had been treated with steroid injections and topical steroids intermittently for her dermatitis […]

Case Presentation: Introduction: Renal cell carcinoma (RCC) is classically associated with the triad of abdominal pain, hematuria, and a palpable mass, but its variability in clinical presentation has earned it the label of “internist’s tumor” (1,2). Liver dysfunction has been observed as a result of metastatic disease and a non-metastatic paraneoplastic syndrome called Stauffer’s syndrome […]

Case Presentation: An 86-year-old male with hypertension, diabetes, and pulmonary tuberculosis on therapy presented to the ED with fever and a rash. He developed an erythematous rash over his body two months prior to admission. At that time, he had completed the initial phase of RIPE therapy and was only on Isoniazid and Rifampin. Both […]