Case Presentation: A 32-year-old healthy female presented with right lower quadrant abdominal pain, hematuria, and easy bruising for four days. She denied prior episodes and family history. On physical exam, she had stable vital signs, gingival bleeding, and hemorrhagic papules on her hands [image 1] and lip. Her labs were significant for: hemoglobin 11 g/dL, [...]

Case Presentation: A 49-year-old male with primary sclerosing cholangitis and newly diagnosed locally advanced cholangiocarcinoma was initiated on 5-Fluorouracil (FU) based chemotherapy (FOLFOX) as an outpatient (Figure 1). Within one day of receiving FOLFOX, the patient presented to the ED with acute, intermittent chest pain radiating to his left arm and shortness of breath. Vital [...]

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 66-year-old man with a history of stage IIId melanoma, who received 6 cycles of Nivolumab, presented with anorexia and persistent large-volume diarrhea. Initial workup included a non-elevated white blood cell count of 6.9 k/mm3 and a creatinine of 1.6 mg/dL from baseline creatinine of 0.8 mg/dL. CT imaging of the abdomen showed [...]

Case Presentation: An 89 year old male presented with itchy red rash over the body since two weeks. His past medical history was significant for Rheumatoid Arthritis (RA) managed with 2.5 mg weekly oral Methotrexate and 200mg daily Hydroxychloroquine for RA. Examination revealed multiple annular purpuric lesions with central erosion on lower extremities, upper extremities [...]

Case Presentation: A 77 year old male with history of diabetes mellitus, systolic heart failure and morbid obesity who presented with multiple episodes of falls occurring over a 2 week period. The patient reported bilateral weakness and pain in the lower extremities, in addition to sensation of paresthesias and numbness. He reported a progressive loss [...]

Case Presentation: A 70 year old male with metastatic malignant melanoma on immunotherapy with nivolumab and ipilimumab was sent to the hospital by his oncologist for abdominal pain and elevated liver enzymes.  His labs were notable for AST 275, ALT 1138, alkaline phosphatase of 394 and total bilirubin of 3.94. This patient had no known [...]

Case Presentation: A 90 year old female, with diabetes mellitus type 2, hypertension and osteoporosis presented to our emergency room with altered mental status for 5 days. The patient had been treated for jaw osteonecrosis over the past 6 months which included multiple debridements and IV antibiotics. She was started on IV ertapenem 1g daily [...]

Case Presentation: A 64-year-old woman with end-stage renal disease (ESRD) on peritoneal dialysis (PD) presented with altered mental status. She reported “seeing monsters when I close my eyes,” “bouncing off the walls like I was drunk,” and slurring her speech at home. Her family added that she was highly functional at baseline, lived independently and [...]

Case Presentation: Asenapine is widely acknowledged as a well-tolerated medication, exhibiting only infrequent severe adverse events1. The necessity of liver enzyme testing remains a topic without a unanimous consensus2. This case study discusses a patient who experienced significant liver damage upon initiating asenapine. As far as our understanding goes, this represents the initial documented instance [...]