Case Presentation: A 57-year-old woman with history of bipolar I disorder treated with risperidone and lithium for over 10 years was sent to the ED for stroke evaluation by her primary care physician due to significant confusion and slurred speech. The patient’s family reported a 3-day history of tremulousness, a week of ataxia with a [...]

Case Presentation: A 37-year-old woman with a history of HTN and ESRD due to preeclampsia now on hemodialysis presented to the hospital for two days of weakness, confusion, and fever. Notably, she had a recent history of blood cultures growing Acinetobacter for which she had received a course of antibiotics. Blood cultures taken at dialysis [...]

Case Presentation: Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by symptoms of encephalopathy and radiographic findings suggestive of vasogenic edema. Although PRES is most often triggered by hypertensive emergencies, sepsis and immunosuppressive medications have also been implicated in its pathogenesis. We present a case of PRES due to lithium toxicity.A 47-year-old female [...]

Case Presentation: A 57 years old female with insignificant past medical history presented to emergency department for right sided chest and back pain for one week that was associated with skin lesions under right breast and adjoining area on the back consistent with herpes zoster rash. She also reported epigastric pain, nausea and vomiting. She [...]

Case Presentation: A 64 year old man with a history of membranous nephropathy on tacrolimus and recent cerebral arteriovenous malformation (AVM) repair, with stent placement seven months prior, presented to the emergency room with one day of progressive lethargy, frontal headache, photophobia, and confusion with subjective fevers and nausea.His vitals on presentation were significant for [...]

Case Presentation: A 59 year-old female with past medical history of Hashimoto’s thyrotoxicosis was admitted because of fatigue, myalgia, acute renal injury with hematuria and proteinuria, positive p-ANCA, positive stool guaiac test, and elevated inflammatory markers. She also had a head CT and MRI done for a new onset of left foot numbness and both [...]

Case Presentation: A 41- year old female with history of hypertension was admitted to our hospital with complaints of intermittent diffuse abdominal pain, diarrhea, and generalized rash. Vital signs were normal. Physical examination was notable for diffuse maculopapular rash. Laboratory investigations showed pancytopenia and acute renal failure. Further investigations were positive for a speckled pattern ANA, [...]

Case Presentation: A 60-year-old female with history of hypertension, rheumatoid arthritis on Adalimumab, and end stage renal disease (ESRD) due to lupus nephritis for which she was recently started on mycophenolate and high dose steroids, presented with 2-3 hour history of sudden onset severe occipital headache, followed by vomiting episodes and complete loss of vision. [...]

Case Presentation: A 67 year old female patient with diffuse large B-cell Lymphoma with extensive nodal disease involving the lower thorax, abdomen, pelvis and central nervous system (CNS) presented with generalized weakness, acute confusion and fevers. Her recent treatment history included systemic chemotherapy with dose adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, rituximab (DA-EPOCH-R) and intrathecal [...]

Case Presentation: A 43-year-old Caucasian woman with stage IV rectal adenocarcinoma metastatic to liver and lung presented with new onset generalized tonic clonic seizures. She was receiving her second line treatment with 5-FU continuous infusion Day number 7 of 7 of the 5th cycle. This was preceded by confusion and altered mentation since the previous [...]