Case Presentation: An 86-year-old man with a history of stroke on apixaban and metastatic renal cell carcinoma on ipilimumab/nivolumab presented to our emergency room with lightheadedness. Transthoracic echocardiogram (TTE) for stroke evaluation performed 3 years prior revealed a patent foramen ovale (PFO). Vital signs were significant for hypoxemia to 85% on room air requiring high-flow [...]

Case Presentation: A 56-year-old male with WHO Group I/III pulmonary hypertension (PH), Gold Stage III COPD, and right ventricular failure presented with several weeks of gradually worsening dyspnea. One month prior, he was hospitalized for an acute exacerbation of PH and was discharged on an increased dose of ambrisentan after excluding intra-atrial shunting. On the [...]

Case Presentation: A 51-year-old woman presented with recurrent confusion and altered mental status over the past 6 months. She reported associated hallucinations, altered sleep cycle and hyper-arousal symptoms. She was treated with lactulose and rifaximin for suspected hepatic encephalopathy with no improvement. She denied any other symptoms. Past medical history was significant for cirrhosis secondary [...]

Case Presentation: An 89-year-old woman with hypertension, dementia, and vertebral fracture was admitted to another hospital because of hip pain after fall. Since she was also found to have oxygen desaturation, the patient was referred to our hospital for further workup. She denied dyspnea, cough, sputum, chest pain, palpitation, episode of aspiration, or fever. On [...]

Case Presentation: A 62yo female with history of Combined Variable Immunodeficiency (CVID), Cirrhosis and Immune Mediated Colitis presented to the hospital with a 7-10 days history of confusion, ataxia, polyuria, and polydipsia. Her medications included Budesonide (9mg po once daily). Patient had no history of diabetes, and non-fasting blood glucose where in normal range 3 [...]

Case Presentation: A 14-year-old female with a history of hydrocephalus status-post ventriculoatrial (VA) shunt placement five years prior presented for acute lethargy characterized by difficulty waking her from sleep. Vital signs were T 36.6 C, pulse 72, respirations 20, BP 148/97, and SpO2 100% with exam notable for lethargy, spontaneous eye and limb movement, pupils [...]

Case Presentation: A 29 year-old woman with sickle cell disease (SCD) on hydroxyurea and L-glutamine, and mild intermittent asthma presented to our institution with right lower extremity and back pain suggestive of a vaso-occlusive crisis. She did not report fever, cough or dyspnea. Vital signs revealed a heart rate of 91/min, blood pressure of 126/86 [...]

Case Presentation: A 50-year-old woman with history of ESRD on PD, CHF, and recent invasive pulmonary aspergillosis on posaconazole presents with three days of gradually progressive shortness of breath and right-sided chest pain. The chest pain was associated with coughing and deep breathing, but non-exertional with no hemoptysis. The patient lived with her sister and [...]

Case Presentation: A 36-year-old female with history of recurrent pleural effusion presented with worsening shortness of breath. One year prior, she was treated for presumed aspiration pneumonia after a moderate left pleural effusion and left lower lobe consolidation were noted on imaging. Initial ultrasound-guided thoracentesis revealed transudative pleural fluid, resolving her symptoms. Despite repeated therapeutic [...]