Background: Panel-based Nucleic acid amplification tests (NAATs) are laboratory tools that are used to detect small quantities of RNA or DNA to rapidly identify a multitude of infectious organisms. A systematic review and meta-analysis looking at the diagnostic accuracy of the BioFire® FilmArray® meningitis-encephalitis (ME) panel which is used at our institution showed that it [...]

Background: The clinical evaluation of febrile neonates ≤ 60 days has been extensively debated in the age of doing less invasive testing to yield the same clinical outcomes with fewer complications. Rates of serious bacterial infections (SBI) in this population have been reported to be between 8.5% and 12%, and up to 20% in neonates [...]

Background: Neonatal herpes simplex virus (HSV) infections are one of the most clinically challenging infections of the newborn period because of the often subtle presentation and devastating consequences of a missed diagnosis. The availability of HSV polymerase chain reaction (PCR) testing has led to widespread use of both HSV testing and empiric therapy but guidelines [...]

Case Presentation: A 31-year-old male with no past medical history presented with fevers and headaches for two days. Patient also complained of malaise, neck stiffness and photophobia. Physical exam notable for positive Kernig’s sign. Labs revealed a leukocytosis with neutrophillic predominance. A lumbar puncture was performed to assess for meningitis. The results were initially consistent [...]

Case Presentation: A 61-year-old female with a history of non-alcoholic steatohepatitis (NASH) cirrhosis complicated by hepatocellular carcinoma (HCC), who underwent a liver transplant 2 months prior, presented to an outpatient clinic complaining of several days of fatigue, headache, nausea, vomiting, abdominal pain and confusion. Her headaches were new since the transplant. She denied any fevers, [...]

Case Presentation: A 70-year-old woman with history of hypertension, asthma, and vertigo presented with acute onset of confusion and slowed speech in the setting of worsening headache, neck stiffness and paralysis of bilateral lower extremities for three days. Her headache was described as bitemporal with burning sensation, worsened by bright light and neck movement, similar [...]

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: Mr. M is a 66 year old man with a history of a kidney transplant and extensive coronary disease with a recent myocardial infarction and code blue arrest 2 months prior to admission. He presented to an outside facility with altered mental status and seizures attributed to severe hyponatremia (Na 115). The patient [...]

Case Presentation: A 29-year-old previously healthy male presented with acute symmetrical joint pain with swelling, back pain, headache, and photophobia. He had no established past medical history and his social history was unremarkable. He was febrile with an examination significant for upper and lower extremity joint tenderness, warmth, and joint swelling in his hands, feet, [...]

Case Presentation: A 51-year-old man was brought in by family for confusion and unsteady gait for a few days. Medical history was significant for alcoholic cirrhosis and prior (2018) cardioembolic strokes with no deficits. Social history was pertinent for drinking multiple beers daily for years. In ED, patient was oriented to name only, tachycardic otherwise [...]