Case Presentation: A 51-year-old African American Female with PMHx of sickle cell trait, vitiligo (developed 5 years ago), T2DM, HTN, unspecified seizure disorder who presented with altered mental status and found to have severe pancytopenia. She presented hemodynamically stable with a physical exam notable for: pale conjunctiva and diffuse skin hypopigmentation consistent with vitiligo. Medications: [...]

Case Presentation: A 73 year-old female presented with significant lethargy and orthostasis with progressive generalized weakness over one week. The patient related that she had experienced increasing fatigue over one year, but that it had acutely worsened in the last two weeks. Upon admission, her vital signs were blood pressure 114/47 mm Hg, heart rate [...]

Case Presentation: A 50-year-old female with a history of alcohol use disorder presented to the emergency department with a one-day history of unsteady gait, decreased lower extremity sensation, and slurred speech. She reported using 20 whippits (recreational inhaled nitrous oxide) daily for the preceding 3-4 weeks. She denied any dietary restrictions. Exam revealed 3+ patellar [...]

Case Presentation: A 75 year old woman with past medical history of hypothyroidism presented with weakness and the sensation of “large folds of skin” on the bottom of her feet. Pertinent physical exam findings included conjunctival pallor, nonspecific diffuse abdominal tenderness, and hyperpigmented macules of the dorsal finger tips and soles, which were also new [...]

Case Presentation: A 38-year-old male with self-reported history of asthma presented with generalized weakness and syncope. He endorsed 2-week of bilateral leg pain with numbness, loss of taste, and nausea. Vital signs were remarkable for tachycardia in 110s and hypotension at 101/52. Labs showed hemoglobin 3.3, WBC 3.6, platelet 83, MCV 93.9, reticulocyte 1.1%, total [...]

Case Presentation: Hemolytic anemia secondary to pernicious anemia is fairly uncommon, and not well described. We present a case of a 39-year-old healthy male with no significant medical history, who presented to the ED for evaluation after a near syncopal episode, along with 2 weeks history of fatigue. In the ED, vitals were unremarkable. Physical [...]

Case Presentation: A 77-year-old female with a history of hypertension and osteoporosis presented to the emergency department with dizziness, fatigue, decreased oral intake, and weakness for a few weeks. She also reported blurry vision and paresthesias in her lower extremities. Physical examination including a neurological examination was normal. Laboratory tests revealed a severe macrocytic anemia [...]

Case Presentation: A 45-year old male was escorted to our tertiary medical center from a prison for evaluation of 40 lb weight loss, paraplegia and recently developed urinary and fecal incontinence. The patient had been on a 7-month long hunger-strike, during which he only consumed one meal per day. In addition to incontinence, he reported [...]

Case Presentation: A 27-year-old male without medical history presented with paresthesias in his hands and feet, and numbness and instability from his waist down for 4 days. The patient initially denied any illicit substances, had no dietary restrictions, and no known medical problems in the family. Cervical MRI revealed T2 dorsal column hypersensitivity consistent with [...]

Case Presentation: A 79-year-old male presented to the emergency department after a witnessed episode of unresponsiveness, jerking motions, urinary incontinence and post-ictal confusion. The patient’s wife denied a history of epilepsy but reported several months of progressive dysarthria and gait ataxia, for which he had been evaluated nine months earlier. Work-up was negative for hemorrhage, [...]