Case Presentation: The patient is an immunosuppressed 57 year old male with small bowel and liver transplant due to trauma from a motor vehicle accident 20 years prior and end ileostomy due to anal carcinoma. His chief complaint was “dizziness,” consisting of lightheadedness and diplopia. His wife described three months of progressive forgetfulness and fabricating [...]

Case Presentation: A 51-year-old African American Female with PMHx of sickle cell trait, vitiligo (developed 5 years ago), T2DM, HTN, unspecified seizure disorder who presented with altered mental status and found to have severe pancytopenia. She presented hemodynamically stable with a physical exam notable for: pale conjunctiva and diffuse skin hypopigmentation consistent with vitiligo. Medications: [...]

Case Presentation: A 73 year-old female presented with significant lethargy and orthostasis with progressive generalized weakness over one week. The patient related that she had experienced increasing fatigue over one year, but that it had acutely worsened in the last two weeks. Upon admission, her vital signs were blood pressure 114/47 mm Hg, heart rate [...]

Case Presentation: Patient is a 71-year-old female who presented to the emergency department due to outpatient labs showing a significant anemia. Her primary complaint was a worsening feeling of generalized weakness over the last four weeks. She denied blood in her stool or urine, or any history of bleeding or clotting disorders. She was found [...]

Case Presentation: A 50-year-old female with a history of alcohol use disorder presented to the emergency department with a one-day history of unsteady gait, decreased lower extremity sensation, and slurred speech. She reported using 20 whippits (recreational inhaled nitrous oxide) daily for the preceding 3-4 weeks. She denied any dietary restrictions. Exam revealed 3+ patellar [...]

Case Presentation: A 43-year-old male with roux-en-y gastric bypass fourteen years ago with complications and multiple adhesions, hiatal hernia associated with nausea and vomiting, and subsequent small bowel resection last year, started to experience cognitive changes and short-term memory loss. He has also experienced problems with balance, generalized weakness, and unintentional 60-pound weight loss. His [...]

Case Presentation: A 32-year-old man with a remote history of alcohol and cocaine use disorders, depression and morbid obesity presented to hospital with numbness in the upper and lower extremities occurring over several months. His symptoms began with numbness and paresthesias in the hands and feet which was intermittent but became constant and spread proximally [...]

Case Presentation: A 38-year-old male with self-reported history of asthma presented with generalized weakness and syncope. He endorsed 2-week of bilateral leg pain with numbness, loss of taste, and nausea. Vital signs were remarkable for tachycardia in 110s and hypotension at 101/52. Labs showed hemoglobin 3.3, WBC 3.6, platelet 83, MCV 93.9, reticulocyte 1.1%, total [...]

Case Presentation: 44 year old male with insulin dependent type 2 Diabetes mellitus and hypothyroidism presented with fatigue, weakness, dyspnea on exertion and light headedness for several weeks. He denied bloody stools or melena. Medications included metformin for the last 3 months, levothyroxine, simvastatin, enalapril and detemir insulin. The patient was adherent to his medical [...]

Case Presentation: A 77-year-old female with a history of hypertension and osteoporosis presented to the emergency department with dizziness, fatigue, decreased oral intake, and weakness for a few weeks. She also reported blurry vision and paresthesias in her lower extremities. Physical examination including a neurological examination was normal. Laboratory tests revealed a severe macrocytic anemia [...]