Background: In sepsis, every hour of delay in antibiotic administration after the onset of hypotension is associated with 4-7% increase in mortality, but little is known about the characteristics of patients with treatment delays. Our objective was to determine if septic adults presenting to the Emergency Department (ED) who receive antibiotics more than 60 minutes [...]

Case Presentation: A 77-year-old African American female with rheumatoid arthritis on chronic prednisolone presented with fever, weakness and unsteady gait. Further history revealed latent tuberculosis (TB) infection treated over 15 years ago and granulomatous abdominal lymphadenopathy three years ago. Physical exam revealed fever and limited left hip mobility due to weakness and pain. Labs showed [...]

Case Presentation: An 80-year-old man with recently-diagnosed pulmonary fibrosis presented to the hospital with ascending bilateral lower extremity pain and weakness. His symptoms began in both feet and calves, and progressed proximally toward his thighs over the past 6 weeks. During this timeframe, his symptoms evolved from being able to ambulate for miles and climb [...]

Case Presentation: A 28-year-old man with recently diagnosed HIV (CD4 57/mm3), not on antiretroviral therapy (ART), presented to the hospital with shortness of breath for several days. He was severely hypoxic, requiring high-flow nasal cannula oxygen. Chest x-ray showed bilateral infiltrates. He was treated empirically with vancomycin and piperacillin/tazobactam for bacterial pneumonia, and Bactrim and [...]

Case Presentation: A 59 year old woman with presumed systemic lupus erythematosus (SLE) was admitted to hospital medicine for severe pancytopenia (WBC 1.3 x109/L, hemoglobin 9.2g/dL, platelet 14×109/L). She had an extensive diagnostic work-up with rheumatology and hematology without a definitive diagnosis; rheumatology questioned her prior SLE diagnosis. Imaging showed diffuse lymphadenopathy and splenomegaly. Three [...]