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Abstract Number: 198

A RARE CAUSE OF TRACHEOESOPHAGEAL FISTULA: DIRECT INVASION BY DIFFUSE LARGE B CELL LYMPHOMA

SHM Converge 2026

Case Presentation: A 83-year-old male with a history of rheumatoid arthritis on methotrexate and heart failure with reduced ejection fraction (45%) presented with six weeks of progressive dyspnea and dry cough. Chest computed tomography (CT) revealed multiple pulmonary nodules and a large left hilar mass causing complete occlusion of the left main bronchus and left [...]

Abstract Number: 199

HIGH-DOSE METHADONE-INDUCED HYPOGLYCEMIA WITH PITUITARY DYSFUNCTION: A CASE REPORT HIGHLIGHTING DIAGNOSTIC AND MANAGEMENT CHALLENGES

SHM Converge 2026

Case Presentation: We present the case of a 49-year-old transgender woman (MTF) with ESRD on hemodialysis and opioid use disorder maintained on high-dose methadone (149 mg/day), who presented with hypotension and profound weakness following suspected volume loss. She was noted to be hypotensive with MAPs in the 40–50s despite 2L IV fluids and 100 mg [...]

Abstract Number: 200

FROM SUSPECTED CSF LEAK TO CAVERNOUS SINUS THROMBOSIS: AN EVOLVING PRESENTATION OF OCCULT OROPHARYNGEAL SQUAMOUS CELL CARCINOMA

SHM Converge 2026

Case Presentation: An 86-year-old woman with a remote history of Hodgkin lymphoma presented with three weeks of headache and one week of intermittent diplopia and fluctuating word-finding difficulty. Head CT and CTA were unremarkable. Brain MRI showed left frontoparietal sulcal FLAIR hyperintensity with asymmetric pachymeningeal enhancement concerning for infection or inflammation, but lumbar puncture was [...]

Abstract Number: 201

WHEN SPEECH FADES FIRST: ISOLATED BULBAR MYASTHENIA GRAVIS IN AN ELDERLY FEMALE

SHM Converge 2026

Case Presentation: An 88-year-old female was admitted to the hospital with a complaint of slurred speech and difficulty swallowing of one week duration. On admission, her vitals were stable. Physical examination was unremarkable aside from an NIH stroke scale score of 1 due to dysarthria. Laboratory evaluation was unremarkable. Head CT and brain MRI were [...]

Abstract Number: 202

BEYOND THE WORKOUT: WHEN RHABDOMYOLYSIS REFUSES TO RESOLVE

SHM Converge 2026

Case Presentation: A 32-year-old woman with a history of hypertension presented with diffuse myalgias, generalized weakness, and mild nausea after attending an exercise class. She denied fever, abdominal pain, chest pain, or dyspnea. Initial laboratory evaluation showed a creatine kinase (CK) level >22,000 U/L, while her complete blood count and comprehensive metabolic panel were within [...]

Abstract Number: 203

CAUGHT IN A RED AND BLUE SQUEEZE: A PLAQUE-FREE CORONARY CRISIS

SHM Converge 2026

Case Presentation: A 44-year-old obese woman with newly diagnosed hypertension presented with syncope preceded by nausea and diaphoresis shortly after taking her first dose of Nifedipine 60 mg, prescribed two days earlier. She denied chest pain, shortness of breath, palpitations, orthopnea, or edema. On arrival, her heart rate was 140 beats per minute, and ECG [...]

Abstract Number: 204

HIDDEN ACID, HIGH STAKES: METFORMIN ASSOCIATED LACTIC ACIDOSIS MASQUERADING AS STARVATION KETOACIDOSIS

SHM Converge 2026

Case Presentation: A 76-year-old woman with hypertension, hyperlipidemia, and type 2 diabetes on metformin presented with seven days of nausea, vomiting, and diarrhea. She had no recent travel, antibiotic use, or sick contacts. On arrival, she was hypotensive and clinically hypovolemic. Laboratory results showed BUN 78 mg/dL, creatinine 7.08 mg/dL (GFR 6 mL/min/1.73 m²), bicarbonate [...]

Abstract Number: 205

SAMPLE, NOT SERUM: IDENTIFYING SPURIOUS HYPOKALEMIA

SHM Converge 2026

Case Presentation: A 45-year-old man with hypertension, hyperlipidemia, prior subdural hematoma s/p craniotomy, and alcohol use disorder presented with progressive weakness, somnolence, and visual changes. He denied cardiac, respiratory, or gastrointestinal symptoms. Laboratory evaluation revealed a white blood cell count of 402,000/µL with 77% circulating blasts, hemoglobin 8.6 g/dL, and platelets 42,000/µL. Venous potassium was [...]

Abstract Number: 206

FISH TANK GRANULOMA: WHEN ENVIRONMENTAL HISTORY MAKES THE DIAGNOSIS IN ATYPICAL MYCOBACTERIAL INFECTION

SHM Converge 2026

Case Presentation: A 53-year-old man with type 1 diabetes mellitus presented with a chronic annular lesion on the right index finger near the distal interphalangeal joint, evolving to involve the hand and forearm refractory to multiple courses of antibiotics (Augmentin, TMP-SMX, doxycycline). Biopsy showed suppurative granulomatous dermatitis with pseudoepitheliomatous hyperplasia. Cultures and serologies were negative. [...]

Abstract Number: 207

A RARE RECURRENCE OF REVERSE TAKOTSUBO CARDIOMYOPATHY AFTER SEVEN YEARS IN THE SETTING OF HYPERTENSIVE CRISIS: A CASE REPORT

SHM Converge 2026

Case Presentation: A 66-year-old woman with a history of Takotsubo cardiomyopathy (2018), paroxysmal atrial fibrillation, hypertension, and dyslipidemia presented with acute abdominal pain, nausea, vomiting, diaphoresis, and hypertensive urgency (BP 202/110 mmHg). She developed hypoxic respiratory distress requiring BiPAP. Transthoracic echocardiography demonstrated preserved ejection fraction (60–65%) with basal hypokinesis and apical hypercontractility, consistent with the [...]

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