Case Presentation: A 51-year-old woman presented with recurrent confusion and altered mental status over the past 6 months. She reported associated hallucinations, altered sleep cycle and hyper-arousal symptoms. She was treated with lactulose and rifaximin for suspected hepatic encephalopathy with no improvement. She denied any other symptoms. Past medical history was significant for cirrhosis secondary [...]

Case Presentation: A 37-year-old woman with a history of HTN and ESRD due to preeclampsia now on hemodialysis presented to the hospital for two days of weakness, confusion, and fever. Notably, she had a recent history of blood cultures growing Acinetobacter for which she had received a course of antibiotics. Blood cultures taken at dialysis [...]

Case Presentation: A 59-year-old previously healthy female presented to the emergency department with progressive cognitive decline, psychomotor retardation, and both auditory and visual hallucinations of subacute onset for which she was previously admitted to inpatient care at two separate hospitals. Extensive testing during these admissions were negative for: infection, metabolic derangement, hematologic malignancy, toxins, heavy [...]

Case Presentation: A 64-year-old female presented to the hospital with 2 days of nausea, vomiting, and diarrhea. She had no recent sick contacts, travel history, or antibiotic use. Her medical history was notable for Hereditary Hemorrhagic Telangiectasia (HHT) complicated by epistaxis refractory to medical and surgical interventions, bleeding gastric ulcers, pulmonary hypertension, and hepatic arteriovenous [...]

Case Presentation: An 80 year old lady presented with fever and confusion since 4 days. She denied any recent trauma, infection, dehydration, medication change, or nutrient deficiency. Her medical history was only significant for anxiety, for which she took alprazolam at home. On physical exam she appeared agitated and disoriented, with a heart rate of [...]

Case Presentation: A hospitalized 71-year-old female became acutely encephalopathic after an esophagogastroduodenoscopy under conscious sedation which was performed to evaluate a chronic esophageal ulcer and other potential causes of dysphagia. Her past medical history was significant for obesity, hypothyroidism, chronic back pain, peripheral neuropathy, colorectal mucinous adenocarcinoma with carcinomatosis and metastases to the lung, chronic [...]

Case Presentation: A 48 year-old male with a past medical history of morbid obesity, hypertension, and poorly nutritious diet consisting strictly of “pizza and chips” who presented after he was found unresponsive and incontinent of urine at home. He reportedly did not consume alcohol. Four weeks prior to presentation, he developed an acute onset of [...]

Case Presentation: An 86-year-old woman with history of EBV encephalitis four years prior presented for altered mental status and emesis in September. Previously, the patient was able to perform all activities of daily living. A week prior to presentation, patient developed a cough and was noted to have slow mentation. Exam was notable for fever [...]

Case Presentation: A 33 year old male with systemic lupus erythematosus (SLE) complicated by recurrent diffuse alveolar hemorrhage (DAH) presented with ataxia, lethargy, cough, and dyspnea. He had been recently exposed to high intensity immunosuppression for his DAH as it was thought to be secondary to SLE. However, it was later diagnosed as herpes simplex [...]

Case Presentation: A 53-year-old gentleman with metastatic adrenocortical carcinoma with liver and lung metastases, was recently started on pazopanib, a non-specific tyrosine kinase inhibitor. He was brought to the hospital by family for increasing confusion and decreased oral intake. He was hemodynamically stable and afebrile on presentation. Initial labs were significant for low platelet count [...]