Case Presentation: A 54-year old male with dementia and chronic kidney disease presented to the emergency room with bilateral lower extremity swelling and blistering in lower legs and calves for several weeks duration. His initial vitals were within normal limits. Examination revealed multiple tense fluid filled bullae in medial lower leg to the foot on [...]

Case Presentation: A 27-year-old homeless African American man with Brugada syndrome, post automatic implantable cardioverter-defibrillator (AICD), initially presented to the hospital for acute onset of chest pain and cough for three days. Initial vitals were unremarkable; exam showed normal heart and lung sounds. EKG showed normal sinus rhythm with no signs of ischemia. AICD interrogated [...]

Case Presentation: A 27-year-old female with a history of PTSD, anxiety, and tobacco use initially presented to the emergency department with the worst headache of her life. Labs were significant for white blood cell count of 18.8 (normal 4.3 – 10.8 x 109 cells/L), troponin of 2.91 (

Case Presentation: A 58-year-old man presented with acute onset of chest pain, vertigo, and ataxia, described as “falling to the right as objects moved to the left.” History included coronary artery disease requiring multiple stents and remote cerebrovascular accident with residual left upper extremity weakness. Exam was notable for vertical nystagmus. EKG showed left atrial [...]

Case Presentation: A 23-year-old woman from Vietnam with no known past medical history presented to her primary care physician due to an abdominal mass. She first noticed the mass one month prior to presentation. It was associated with abdominal bloating and worsening sharp abdominal pain as well as a five-pound weight loss and decreased appetite. [...]

Case Presentation: A 73-year-old male presented to the ER with right-sided facial droop for 2 days. He had a recent history of multiple insect bites and had noticed a bull’s eye rash about 4 weeks back. He did not have any GI or GU symptoms. No history of recent surgery or trauma. His diet was [...]

Case Presentation: A 68 year old female patient presented to the emergency department after being found down at her house. On exam she was found to be confused and disoriented. Lab work showed severe pancytopenia, and elevated bilirubin with no associated elevation of LFTs. She was transfused with 2 units of packed red blood cells [...]

Case Presentation: 48-year-old female with past medical history of cirrhosis secondary to HBV (on entecavir) and EtOH, decompensated by hepatic encephalopathy and ascites, coronary artery disease s/p stenting to LAD in 2009 presented to the hospital with abdominal pain and distension for a 1-week duration. She stated that the pain radiated to her back and [...]

Case Presentation: A 61-year-old woman with no pertinent past medical history presented to the hospital with two months of progressive numbness that began with her left foot and hands and eventually extended to her forearms. She developed clumsiness in her hands, gait unsteadiness, and had a 20-pound weight loss. A CT scan of the chest [...]

Case Presentation: We present the case of a 58 -year-old opioid naïve man admitted for elective knee arthroplasty received parenteral hydromorphone and enteral oxycodone for analgesia. On post-operative day one, he developed abdominal pain. Abdominal X-ray showed stool burden suggesting constipation (OIC) prompting management with laxatives; he was given 12 mg parenteral methylnaltrexone. Overnight he [...]