Background: Using evidence-based clinical pathways has been shown to improve mortality in patients with staphylococcus aureus bacteremia. However, little is known if these pathways can decrease antibiotic use as a means of antibiotic stewardship in patients with suspected contaminated blood cultures. Purpose: We aim to decrease antibiotic use in clinically stable patients with likely gram-positive [...]

Case Presentation: A 50-year-old Filipino man with poorly controlled type 2 diabetes mellitus presented with 4 days of fever, abdominal pain and distention. He endorsed unintentional weight loss of 30lbs over the last year as well as a chronic cough. The physical exam was notable for bibasilar lung crackles and abdominal distention with diffuse tenderness [...]

Case Presentation: 37 year-old male with a medical history significant for intravenous drug usage presented with three years of progressive generalized symptoms including weight loss, fevers, and shortness of breath. The patient started to experience worsening fatigue, drenching night sweats and an unintentional weight loss exceeding 20 pounds over several months leading to admission. Upon [...]

Case Presentation: Disseminated Coccidioidomycosis is a rare fungal infection that can have various presentations in a hospitalized patient. Given the high mortality rate associated with delayed diagnosis, it is essential to keep this rare infection on the differential. A previously healthy 37-year-old Hispanic male presented with a one-month history of cough, high-grade fevers, night sweats, 15-pound [...]

Case Presentation: An 82-year-old, Samoan male with history of poorly controlled diabetes, hypertension, COPD, and pulmonary coccidioidomycosis on fluconazole therapy (400 mg/day) was referred to the hospital by his primary doctor for treatment of a left ankle ulcer and cellulitis that had not responded to ten days of outpatient amoxicillin-clavulanate therapy. He had no constitutional [...]

Case Presentation: A 38-year-old male dentist presented with several days of bilateral lower extremity rash and migratory large joint arthritis in the setting of fevers, myalgias, and a recent viral illness in his 3-year-old daughter. His medical history included remote testicular cancer post-orchiectomy. He was referred by his primary care provider who noted bilateral (right [...]

Case Presentation: 61 year old Hispanic male with a history of end-stage renal disease receiving scheduled hemodialysis, type 2 diabetes presented with 2 months of progressive abdominal pain and distension, anorexia, and intermittent fevers. He had lived in Fresno, Ca for over 20 years. Five months prior, he was diagnosed and treated for COVID-19 pneumonia. [...]

Case Presentation: A previously healthy 50-year-old man presented with 4 days of abdominal distension and subjective fevers at home. He was from rural Guatemala originally, now moved to Irvine, California. He denied any noxious habits including alcohol consumption, other travel history, or occupational exposures. On presentation, vital signs were stable except for slight tachycardia to [...]

Case Presentation: An 18 year old male in Florida with a history of asthma developed frontal headaches three months ago. He was diagnosed with sinusitis, and was prescribed oral amoxicillin/clavulanic acid. However, within two weeks his headaches worsened, fevers developed, and his family observed him walking into walls. At an outside hospital, his lumbar puncture [...]

Case Presentation: Progressive dysphagia associated with weight loss is usually related to upper gastrointestinal cancer. As a differential diagnosis, fungal infections may present with a similar clinical presentation due to upper GI lesions. Paracoccidioidomycosis (PCM) infection is a systemic granulomatous disease caused by the fungi Paracoccidioides brasiliensis, especially important in rural areas of Latin America. [...]