Background: The opioid epidemic continues to exert a significant impact on our health care system. Patients with intravenous drug use (IVDU) often develop life threating infections leading to prolonged hospitalizations with poor outcomes. Traditionally, the focus of treatment during these hospitalizations is on the infectious complications with very little emphasis on the underlying substance use [...]

Background: Osteomyelitis is an acute or chronic infection of the bone structures which can be caused by either bacteria, fungi, or mycobacteria. Studies have reported a high annual incident of about 1 in 675 hospital admission in the United States. The overall incident is higher in the male population for reasons unclear and increases with [...]

Background: Hospitalizations related to injection drug use (IDU) are often complicated by complex psychosocial circumstances and behavioral health needs. Despite growing hospitalizations amongst this patient population, little is known about physician experience caring for these patients. Our study aims to explore physician perspectives in caring for patients with IDU to understand the impact of these [...]

Case Presentation: 70-year-old male with remote past medical history of prostate cancer and COPD presented to the emergency department with new onset left side weakness along with left side facial droop. Patient underwent CT scan of the head which was negative and an MRI of the brain which showed multiple bilateral small strokes that raised [...]

Case Presentation: A 29-year-old male presented with a 1-week history of dyspnea, cough, fever, fatigue, myalgia, and chest pain. Medical history included hepatitis C and intravenous drug use with meth, heroin, and suboxone. His last use was 1 week prior to presentation with IV suboxone. Pertinent surgical history consisted of bioprosthetic mitral valve replacement x2. [...]

Background: Echocardiography is an essential evaluation in the diagnosis of infectious endocarditis (IE). Transthoracic echocardiography (TTE) is a portable study that is widely available and non-invasive. Though transesophageal echocardiography (TEE) is traditionally known for higher sensitivity and specificity, it is speculated that improvements in modern TTE imaging could produce higher diagnostic yield than previously thought. [...]

Case Presentation: A 62 year old male with past medical history of DVT, prostate cancer diagnosed 2 years ago, presented to the hospital complaining of 1 day weakness in his left upper and lower extremities. Head CT revealed a sub-acute right side ischemic infarct. Physical exam was significant for jaundice, left facial droop, left tongue [...]

Case Presentation: A 45-year-old-man with no prior medical history presented to the emergency department with a symmetric lower extremity rash and recurrent fevers. The rash started two weeks prior as discrete mildly pruritic red lesions on his ankles and spread to his arms, torso and back. He subsequently developed recurrent fevers up to 38.9°C on a [...]

Background: People who inject drugs (PWID) are at high-risk for developing serious injection related infections requiring long-term IV antibiotic therapy. For infective endocarditis, current guidelines recommend at least 4 to 6 weeks of IV antibiotic therapy. In PWID, it is recommended this be completed in a supervised setting because discharge home with a PICC line [...]

Case Presentation: A 53 year-old man with a history of Hodgkin’s lymphoma status post splenectomy, mantle radiation, and ABVD chemotherapy, severe aortic stenosis, and moderate mitral stenosis attributed to chemoradiation presented with recurrent fevers and lower abdominal pain. He also reported six years of migratory polyarthritis formerly on prednisone and methotrexate, 45kg unintentional weight loss, [...]