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Abstract Number: 455

DIAGNOSTIC AND THERAPEUTIC CHALLENGES OF MULTISYSTEM ERDHEIM-CHESTER DISEASE IN A BRAF-WILD-TYPE, MAP2K MUTANT PATIENT

SHM Converge 2026

Case Presentation: A 79-year-old man with hyperlipidemia and depression presented to the ED with a suprapubic mass. After discharge with a nondiagnostic biopsy, he returned several months later with progressive vison loss, orbital cellulitis, and proptosis (Fig. 1). He also developed persistent left lower extremity swelling and erythema refractory to antibiotics (Fig. 2), along with [...]

Abstract Number: 456

PERSISTENT DEEP VEIN THROMBOSIS ON APIXABAN UNMASKS ATYPICAL MAY-THURNER SYNDROME AFTER LUMBAR FUSION

SHM Converge 2026

Case Presentation: A 73-year-old woman with Charcot-Marie-Tooth disease underwent T11-pelvis spinal fusion in October, complicated by a surgical site infection. In late December, she was diagnosed with a left peroneal vein deep vein thrombosis (DVT) and started on apixaban. One week later, she returned to the emergency department with worsening left lower extremity swelling and [...]

Abstract Number: 457

BREAKING THE CYCLE: KETAMINE AS AN OPIOID SPARING BRIDGE IN REFRACTORY GASTROPARESIS

SHM Converge 2026

Case Presentation: A 23-year-old woman with type 1 diabetes mellitus, multiple previous hospitalizations for diabetic ketoacidosis (DKA), and severe gastroparesis presented with persistent nausea, vomiting, and abdominal pain. Her history included a remote gastric surgery of unclear type. CT abdomen/pelvis and esophagram with oral contrast showed no mechanical obstruction. Despite optimized antiemetic and prokinetic therapy, [...]

Abstract Number: 458

THE MISLEADING FEVER CURVE: A CHALLENGING CASE OF HYPERTRIGLYCERIDEMIA-INDUCED ACUTE PANCREATITIS

SHM Converge 2026

Case Presentation: A 33-year-old male with no medical history presented with severe epigastric pain radiating to the back. He was diagnosed with acute interstitial edematous pancreatitis secondary to hypertriglyceridemia (HTG) >4,425 mg/dL and new diabetic ketoacidosis (DKA) due to undiagnosed type II diabetes (GAD-65 antibodies negative). He received IV fluids, insulin, fenofibrate, and pain control. [...]

Abstract Number: 459

SWEET SYNDROME IN REFRACTORY AML: A CASE OF ACUTE FEBRILE NEUTROPHILIC DERMATOSIS IN A NEUTROPENIC PATIENT

SHM Converge 2026

Case Presentation: A 45 year old male with relapsed refractory AML status post multiple lines of therapy including stem cell transplant (most recently on revumenib), with concern for graft versus host disease of the skin (on ruxolitinib and prednisone), was admitted for neutropenic fever. His BP was 104/68 and respiratory rate was 20. On exam [...]

Abstract Number: 460

CATCHING MORE THAN BREATH: EXERCISE-RELATED SUBCUTANEOUS EMPHYSEMA

SHM Converge 2026

Case Presentation: A 26-year-old woman with well-controlled asthma presented with facial swelling after completion of a 21-mile open ocean swim 2 days prior to admission. She was stung multiple times by jellyfish and swam against the current. She described feeling as though she was breathing through a straw but attributed this to exertion, although prior [...]

Abstract Number: 461

WHEN THE CURE CLOUDS THE MIND

SHM Converge 2026

Case Presentation: Valacyclovir (a pro-drug of acyclovir) is a commonly used antiviral medication that can have the rare side effect of neurotoxicity and acute kidney injury. A 77-year-old woman with past medical history of acid reflux and recurrent urinary tract infections presented with confusion and falls. Three days prior to admission, she was diagnosed with [...]

Abstract Number: 463

CANCER UNTIL PROVEN OTHERWISE: AN UNUSUAL CAUSE OF GASTRIC OUTLET OBSTRUCTION

SHM Converge 2026

Case Presentation: A 65-year-old woman with a history of opioid use disorder presented to the emergency department with abdominal pain and vomiting. Without her methadone, she was in withdrawal and vitals were notable for tachycardia (101 bpm) and hypertension (184/105 mmHg). History was limited by anxiety and discomfort. Physical examination revealed cachexia with a Body [...]

Abstract Number: 464

AN UNUSUAL PRESENTATION OF OBSTRUCTIVE RENAL FAILURE DUE TO PERITONEAL CARCINOMATOSIS

SHM Converge 2026

Case Presentation: A 56-year-old female with a history significant for triple-negative breast cancer with peritoneal carcinomatosis, previously complicated by malignant pleural and pericardial effusions, presented to the emergency room with dyspnea and oliguria. She denied preceding trauma or infection, flank or abdominal pain, hematuria, dysuria, and new medications. She had no prior history of kidney [...]

Abstract Number: 465

OLMESARTAN-INDUCED ENTEROPATHY IN AN ELDERLY PATIENT WITH REFRACTORY DIARRHEA AND WEIGHT LOSS

SHM Converge 2026

Case Presentation: An 83-year-old female patient with a history of esophageal strictures, GERD, dysphagia, pancreatic insufficiency, hypothyroidism, and hypertension presented directly from GI clinic with four months of watery diarrhea (6-16 stools daily), profound weight loss (~40 lbs), and decreased oral intake. The patient presented to outside hospitals on several occasions and was provided symptomatic [...]

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