Case Reports

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Intentional Flecainide Overdose

Nicholas Coriasso, Daniel Grahf, Mir Babar Basir, and Gurjit Singh

Flecainide acetate is a class 1C antiarrhythmic most often used for supraventricular arrhythmias. Intentional overdose of flecainide is rare and life threatening. Flecainide depresses all conduction pathways, manifesting with prolongation of the PR interval and QRS interval on electrocardiogram (EKG) making these patients highly prone to fatal arrhythmias. This case provides a unique view into the chronologic evolution of EKG findings after intentional ingestion of around 3000 mg of... Read More
An Atypical Case of PCP Pneumonia in a Patient on Chronic Immunosuppression

Carina Dagher, Raef Fadel, Sophia Binz, and Norman Markowitz

Introduction: Pneumocystis pneumonia (PCP) is an opportunistic infection caused by Pneumocystis jirovecii (previously Pneumocystis carinii), a yeast-like fungus colonizing up to 20% of immunocompetent adults. Progression from colonization to infection can occur in immunocompromised settings, however differentiating the two can be difficult. Diagnosis traditionally involves three core measures: diffuse bilateral infiltrates on chest x-ray, respiratory symptoms, and identification of Pneumocystis in sputum or bronchoalveolar lavage (BAL). Novel diagnostic modalities... Read More
Pseudoaneurysm of the Breast: An Uncommon Complication of Core Needle Biopsy

Alexis A. Davenport, Paul Williams, David Pickney, and Mark Segel

A 61-year-old female presented with persistent pain in the left breast following benign core needle biopsy. Diagnostic mammogram demonstrated a new small circumscribed mass in the upper outer quadrant of the left breast directly adjacent to the previously biopsied mass. Subsequent targeted Color Doppler ultrasound revealed a vascular mass with to and fro pulsatility. A diagnosis of breast pseudoaneurysm was made, a known albeit rare complication of breast core... Read More
Invasive streptococcus pneumoniae in an immunocompetent host

Zachary Demertzis and Sara Stanley

Introduction: Invasive streptococcus pneumoniae (ISP) is an isolated infection of Streptococcus pneumoniae in normally sterile sites (e.g. blood, CSF, synovial fluid). It is typically seen in adults >65 years of age or children <2 years of age and immunocompromised individuals. Mortality rates range between>15-20% and are highest during the first 72 hours after bacteremia is identified. S. pneumoniae is an uncommon cause of infective endocarditis (IE). The extent of... Read More
Case of Pneumocystis Pneumonia 6 Years Post-Renal Transplant while on Everolimus

Nikita Desai and Ayooluwa Ayoola

Goal of Case report: Presentation of PCP >1-year post-transplant and role of prophylaxis and immunosuppression in transplant patients.Abstract :Pneumocystis pneumonia (PCP) is a rarely occurring pulmonary infection that affects the immunocompromised, and often presents with nonspecific symptoms especially when compared to drug induced pneumonitis.Our patient, a 73-year-old female, presented to the emergency department with a 2 week history of shortness of breath and generalized weakness. She had a recent... Read More
Keep Your Differential Broad This Back Pain Season Penetrating Aortic Ulceration: A Case Report

Kyle Diaz and Anthony Colucci

Abstract: Keep Your Differential Broad this Back Pain Season, Kyle Diaz D.O., Anthony Colucci D.O. The chief complaint of back pain is a common occurrence in the emergency department. Our departments can often be inundated with this complaint especially now that the season of slips and falls is upon us. We are not only seeing traumatic back pain but chronic back pain and atraumatic acute back pain frequent the... Read More
Pseudoaneurysm as the Cause of Rectal Bleeding after Low Anterior Resection

Sarah Diaz, Quynh Lee, and Jon Hain

Introduction: A pseudoaneurysm (PSA) represents an area of fibrous encapsulation around a pulsatile and expanding hematoma that occurs from arterial bleeding into adjacent soft tissue1. Visceral artery aneurysms and PSAs are relatively rare with a reported incidence of 0.01 to 0.2% in routine autopsies2. The splenic artery is the most common site of aneurysmal disease, followed by the hepatic arteries, and SMA2. Visceral PSA is most commonly caused by... Read More
ED Management of Status Epilepticus in Pediatric Patient with Dravet Syndrome

Alissa DiMichele and Jason Muir

Case Presentation: Pediatric Patient With Rare Early-Onset Epilepsy Syndrome Presenting in Status Epilepticus ED Management of refractory status epilepticus in Pediatric Patient with Dravet Syndrome. 21 month old female with past medical history of Dravet Syndrome presenting to the ED via EMS for status epilepticus. Patients mother reported 20 minutes of seizure like activity at home described as focal right upper extremity twitching and fixed right gaze. She was... Read More
Differentiating TTP from Hypertensive Hemolytic Anemia

Chelsea Dixon-Dionne, Robert Curtis, Adele Amine, Joseph Abbo, and Rajika Munasinghe

Introduction: It is established that Focal Segmental Glomerulosclerosis (FSGS) can lead to difficult to control hypertension. It has also been shown that malignant hypertension can cause microangiopathic hemolytic anemia (MAHA). We present an interesting case of a young patient who we believe developed undiagnosed FSGS that led to hypertension. Without diagnosis and appropriate treatment, the patient presented with hypertensive crisis, acute renal failure, and MAHA. Case description: Our patient... Read More
A Rare Case of Bullous Eruptive Disseminated Porokeratosis

Morgan Ellis, Chelsea Fidai, and Holly Kerr

INTRODUCTION: Porokeratosis is a disorder of keratinization that comprises a heterogenous group of conditions characterized by atrophic patches bordered by a clinically and histologically distinctive hyperkeratotic ridge known as the coronoid lamella. Its most common variant, disseminated superficial actinic porokeratosis (DSAP), is most commonly inherited in an autosomal dominant manner, however, immunosuppression has been shown to induce sporadic disease. Exacerbation of preexisting DSAP lesions represents a subset of acute... Read More
Unilateral Leg Swelling with Negative Deep Vein Thrombosis by Ultrasound

Timothy Evans, Felicity Fisk, Nicole Mott, Patrick Buckley, Matthew Easton, and Michael Mott

Introduction: Swelling and pain in a lower extremity is a common presenting complaint to the emergency room. Work-up often includes radiographs and ultrasound to rule out a deep vein thrombosis (DVT). Unfortunately, vascular ultrasounds which are negative for DVT may be mistaken as a definitive anatomic study by treating physicians. It is essential for physicians to consider that underlying malignancies, including soft tissue sarcomas, may be the cause of... Read More
The Neurologic Sequelae of Undiagnosed AIDS: A Case Report

Michelle Eventov, Kristin Weider, Raef Fadel, Ahmad Omar Aljamal, Fan Chen, and Mohammed Ferras Dabbagh

Case Presentation: A 33-year-old male without significant medical history experienced visual changes, left-sided tingling and weakness, vertigo, nausea, and mild expressive aphasia for 2 months. At that time he had mild upper extremity tremor and was able to walk, drive, and perform activities of daily living. On physical exam at Henry Ford Hospital, the patient demonstrated left upper extremity dysdiadochokinesia, bilateral upper extremity dysmetria, slowed speech, and extreme nausea... Read More
NSTEMI Progressing to STEMI in a Healthy Young Female

Raef Fadel, Hanan Ibrahim, Robert Solomon, Benjamin Swanson, and Deirdre Mattina

Introduction: Spontaneous Coronary Artery Dissection (SCAD) is a rare cause of acute coronary syndrome (ACS) in healthy individuals. There are no risk stratification tools for the prevention of SCAD and no clear guidelines for acute management. The use of traditional ACS therapies, including antiplatelets agents, anti-thrombotics, beta-blockers, and statins, remains controversial.Clinical Case: A 40-year-old female with hypertension and distant history of postpartum pre-eclampsia presented with sudden onset, substernal chest... Read More
Necrotizing Cavitary Lung Mass in Patient with AIDS: A Rare Manifestation of PCP

Raef Fadel, Daniel Ouellette, Aula Ramo, Sophia Binz, and Odaliz Abreu-Lanfranco

Introduction: Pulmonary infections in immunocompromised hosts encompass a wide differential diagnosis. Of the possible etiologies, Pneumocystis jirovecii presents as a rare cause of necrotizing cavitary pneumonia, particularly in patients with advanced HIV and AIDS. We present the case of a cavitating lung lesion in a patient with AIDS, as an example of this rare atypical manifestation of Pneumocystis, hoping to increase clinical awareness and assist in prompt diagnosis and... Read More
A Slow Growing Verrucous Plaque on the Scalp

Caitlin Farmer, Joseph McGoey, and Ben J. Friedman

A 73 year-old Caucasian male with a history of multiple non-melanoma skin cancers presented to dermatology for evaluation of a growth on the left scalp. He endorsed that the lesion had been present for many years but was slowly growing larger and thicker and had recently bled spontaneously and become intermittently painful. The lesion had been evaluated several times over a span of 3 years and was previously thought... Read More
A Rare Case of Tolosa-Hunt Syndrome

Naureen Farook, Sam Tirgari, and Jacqueline Pflaum-Carson

A 27-year old female with no past medical history presented to the ED multiple times with intractable headaches and blurry vision. Her symptoms involved a right-sided throbbing pain for 6 weeks with recent onset of progressively worsening blurry vision with increasing right eye pressure. She had multiple ER visits, PCP appointments, as well as ophthalmology and neurology evaluations. Her CT and MRI images did not reveal any abnormalities initially,... Read More
Giant Cell Tumor of the Distal Radius: Reconstruction with Masquelet Technique and Freeze Dried Fibula

Felicity E. Fisk, Nicole Mott, Patrick Buckley, Matthew Easton, and Michael Mott

Purpose: Giant cell tumor (GCT) of the distal radius often exhibits a more aggressive disease course with increased rates of local recurrence and subsequent increased need for resection over curettage. In cases where resection of the distal radius becomes necessary, a variety of reconstructive techniques exist without notable clear superiority of any one. Presented here is a small series of GCT of the distal radius treated with resection of... Read More
Acute Aortic Dissection Presenting with Massive Hemoptysis and History of TAVR

William Fletcher, Christopher Nedzlek, and Satheesh Gunaga

Aortic dissection is a rare and life-threatening condition that frequently mimics more common causes of chest pain. This often leads to a missed or delayed diagnosis which can have disastrous consequences for the patient. It is imperative that physicians recognize the variable presentations of this life-threatening illness as early diagnosis and treatment are crucial to the outcome of the patient. We present the case of a 77-year-old female with... Read More