Case Presentation: Insulin-derived amyloidosis (AIns) is a rare, iatrogenic localized dermatological condition associated with insulin injections that can be a missed diagnosis in those with poorly-controlled diabetes. A 53-year-old caucasian woman with a history of T1DM, Graves’ disease, and a thyroid nodule came to the clinic to establish care. The patient complained of painless, palpable [...]

Case Presentation: A 57 year old man with a history of heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD) and hypertension presented with two weeks of exertional dyspnea and lower extremity edema, followed by 4-days of progressive tongue swelling. One-month prior, he was initiated on an ACE inhibitor (ACEi) and experienced tongue [...]

Case Presentation: An elderly male with a pertinent past medical history of carpal tunnel syndrome, and chronic diarrhea, presents with complaints of progressively worsening anasarca and associated dyspnea. He has had multiple hospitalizations for dyspnea over the last six months, thought to be due to transudative pleural effusions. Outpatient work-up, including echocardiogram and subspecialty consultation [...]

Case Presentation: A 65-year-old Caucasian male with history of recurrent pulmonary embolism on chronic warfarin and hypertension was transferred from a nursing home to the hospital for shortness of breath and cough for two days. He was initially treated for healthcare associated pneumonia and later developed clostridium difficile colitis. He was noted to have severe bilateral lower extremity edema, which he [...]

Case Presentation: Ms. S is a 64 year old woman recently diagnosed with multiple myeloma following a hip fracture and repair, who was transferred from an outside hospital for hematochezia. She was admitted to the outside hospital from a skilled nursing facility for presumed post-operative ileus complicated by nausea and vomiting. During that stay, she [...]

Case Presentation: 59 years old Hispanic male with history of alcoholic cirrhosis, esophageal varices that presented with 1 day history of abdominal pain and worsening renal function. Patient gets therapeutic paracentesis every 2 weeks, and the last one was one day prior his presentation. He was seen by his PCP who instructed him to present [...]

Case Presentation: A 46-year-old healthy man presented with bilateral limb swelling, shortness of breath, fatigue, and orthopnea for one week. A transthoracic echocardiogram revealed a decreased ejection fraction (35-40%), severe pulmonary hypertension, diffuse hypokinesis, and significantly increased left ventricular wall thickness. Notably, he had presented with similar symptoms seven months earlier. At that time, he [...]

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 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 [...]