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  Conservative Management of Spontaneous Coronary Artery Dissection: A Case Report

  Abel Ignatius, Paul Nona, and Bobak T. Rabbani

  Introduction: Spontaneous coronary artery dissection (SCAD) is a rare but fatal cause of acute coronary syndrome (ACS), often seen in young healthy women without any significant cardiovascular disease. If not treated early, it can lead to sudden cardiac death. We report an interesting case of ACS due to SCAD.

  Case Presentation: A 40-year-old woman presented to the emergency department with retrosternal chest pain at rest, associated with diaphoresis, palpitations,... Read More

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  A Vast-us Differential on Knee Pain

  Sharon Im and James Moeller

  12 year-old male football player presents to the sports clinic for evaluation of 1.5 years of left lateral knee pain.

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  Combined Hepatocellular Carcinoma and Neuroendocrine Carcinoma Presenting with Hypercalcemia

  Rim S. Ishak, Abigail L. Entz, Sanam Husain, and Eric Scher

  Background: Malignancy-associated hypercalcemia (MAHC) occurs in 20-30% of cancer patients and is a common cause of hypercalcemia among hospitalized patients. Its pathophysiology is generally based on bone metastases or the production of parathyroid hormone-related peptide (PTHrP) by tumor cells. The secreted PTHrP causes hypercalcemia via increased calcium absorption at the kidney and increased bone resorption. Here, we present a rare case of combined hepatocellular carcinoma (HCC) and neuroendocrine carcinoma... Read More

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  An atypical presentation of Liposarcoma: Primary involvement of the liver with secondary metastatic seeding

  Inara Ismailova, Vichar Trivedi, Khaled Almadhoun, and Jasmine-Yasmine Omar

  A 61-year old male with PMH significant for gastric bypass, anxiety/depression, and previous alcohol abuse, presented to the ED with 10-day history of SOB and abdominal distention. He endorsed difficulty taking deep breaths, urinating, and bowel movements. He denied any unexplained weight loss, night sweats, or history of ascites. Physical exam revealed abdominal distension and tenderness. Hepatitis screen, AFP, CEA, and CA19-9 were negative. AST, ALT, total bilirubin, and... Read More

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  Case Report: Hypersensitivity Mediated ST-Elevation Myocardial Infarction—“Kounis Syndrome with Cronovich Phenomenon”

  Joseph Jabour and Heather Cronovich

  Introduction: ST elevation myocardial infarction in concurrence with angioedema, anaphylaxis, hypersensitivity, or platelet activation is an event well published in literature known as Kounis-Syndrome. Classically, these events are linked by the administration of epinephrine either intravenously or intramuscularly for the treatment of the acute immunologic response.

  Case Report: This particular case is a 78 year old male with history of c1 esterase inhibitor deficiency, angioedema, and hypertension presenting with... Read More

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  Recurrent benign lymphocytic meningitis in a 66-year-old male diagnosed with Mollaret syndrome. Is suppressive therapy necessary?

  Khaled Jamoor, Rita Kassab, and Niluka Weerakoon

  Mollaret syndrome is a rare form of recurrent lymphocytic meningitis. It is defined as recurrent episodes of acute attacks that last usually few days and separated by symptom free periods that can last months to years. Herpes simplex virus 2 (HSV-2) is responsible for the majority of cases. Diagnosis is usually made by isolating the virus DNA from the CSF. Treatment with antivirals as a herpetic infection has been... Read More

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  Athlete Safety: Inappropriately Sized Gear is Not Worth a Hill of Beans

  Timothy Jelsema, Bradley Jaskulka, and James Moeller

  A male high school athlete sustained an abdominal injury playing football due to wearing inappropriately sized protective equipment. Work-up and case as described in the poster.

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  Respiratory Epithelial Orbital Cyst: A Rare Cause of Globe Displacement

  Man Li (Elina) Jin and Christian George

  A 55-year-old man presented with a right sided orbital mass causing globe displacement and diplopia. The mass was excised and histopathology findings were consistent with a respiratory epithelial orbital cyst, a type of choristoma. Choristomas represent normal tissue growing in an abnormal location. This unusual orbital cyst may originate from a rest of respiratory epithelium during development, or through seeding of paranasal sinus respiratory tissue from trauma. This isolated... Read More

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  Take a Stab at It! Percutaneous drainage via normal variant sternal foramen

  Joseph Joshua and John Bonnett

  Our patient was an 81 year-old female with a history of multiple esophageal dilations with a large distal esophageal perforation, status post fully covered metal stent placement. CT Thorax showed a mediastinal fluid collection exerting mass effect on the right heart, incidental note was made of a sternal foramen (Panel 1, arrow). Interventional Radiology was consulted for drainage. Utilizing Seldinger technique, a 5-Fr introducer (Panel 2) followed by a... Read More

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  You See, I See, We All See UC

  Katherine Joyce, Jody S. Chou, and Zachary Hanna

  A 21 year old male with a six month history of biopsy-proven ulcerative colitis presented to Henry Ford with worsening abdominal pain and rectal bleeding despite steroid therapy. Upon CT evaluation, the patient was found to have a significant mass of the descending colon. Biopsy was completed and showed EBV+ B-cell lymphoma. The patient’s clinical course was complicated by bowel perforation, but he was ultimately able to receive chemotherapy... Read More

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  Granulomatosis with polyangiitis presenting as vision loss and sinus disease

  Daniel Kaitis and Swapna Vemuri

  A 32 year-old female with a past medical history of several years of intranasal cocaine usage, bipolar disorder type 1 and no ophthalmic history presented with vision loss in the right eye for 2 weeks duration. Visual acuity in the right eye was count fingers at 1 foot. Patient had a pronounced relative afferent pupillary defect, deficiency in abduction of the right eye, and mild disc edema. Imaging showed... Read More

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  Insulin Induced Edema: A Rare Effect of a Common Medication

  Megan Karrick, Ahmad Aljamal, and Danielle Heidemann

  A 75 year old female with type 2 diabetes, hypertension, and chronic kidney disease presented to the clinic for generalized edema. She endorsed associated nausea, but denied chest pain, shortness of breath, and orthopnea. It began after the initiation of insulin glargine for uncontrolled hyperglycemia. Initially, she developed profound swelling in her legs to the thighs, which progressed in two months to involve her upper extremities and torso. She... Read More

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  Paradoxical Psoriatic Arthritis with the Initiation of Brodalumab and Guselkumab

  Reem Kashlan, Kristin Slater, and Francisca Kartono

  Paradoxical plaque psoriasis reactions have been reported with the usage of biologics, primarily with the use of anti-TNF agents. Brodalumab, a human monoclonal antibody against interleukin-17 receptor A (IL17RA), and, guselkumab, an interleukin-23 blocker, are biologic agents that have been proven to be effective against psoriasis and psoriatic arthritis. We report a case of a 47 year old white male with a long standing history of psoriatic arthritis with... Read More

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  An Unusual Case of Cardiovascular Collapse After EVALI

  Christopher Kassab, Aeman Hana, Zachery Bauer, Sophia Binz, Harish Kinni, and Jennifer Swiderek

  Introduction: In July of 2019, a new respiratory illness emerged as a cluster of healthy, young adolescents developed profound hypoxic respiratory failure. Investigation revealed that it was related to e-cigarette and vaping use. A new clinical syndrome of e-cigarette and vaping use-associated lung injury (EVALI) emerged. Its development was linked to tetrahydrocannabinol (THC) use and Vitamin E acetate. We present a case of vaping associated lung injury, resulting in... Read More

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  A case of suspected delirious mania treated with benzodiazepines

  Hala Katato, Mohan Gautam, and Esther Akinyemi

  Delirious mania is a life-threatening syndrome characterized by rapid onset of delirium, mania, psychosis, and catatonia. It is crucial to include this in a differential as this condition responds poorly to traditional pharmacotherapeutic management of delirium or mania. Here, we present the case of a 71-year-old African American woman who was hospitalized with symptoms presenting as hyperactive delirium. She was found to have a UTI, which was treated, and... Read More

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  Chicken Coop-Induced Hemophagocytic Lymphohistiocytosis

  Ahmed Kazem and Odaliz Abreu-Lanfranco

  Introduction: Hemophagocytic lymphohistiocytosisis (HLH) is a rare and often fatal condition characterized by an overactive but ineffective response of the immune system. There have been several documented causes, which include genetic predisposition, malignancy, infection, autoimmune disease, and chronic immunosuppressive therapy.

  Case Presentation: A 42 year-old woman with a two year history of ankylosing spondylitis, who was recently initiated on Infliximab, presented with abdominal pain, fevers, and jaundice. She had... Read More

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  Case Report: New onset of febrile episodes on low doses of Clozapine in SICU setting

  Adan Khan, Christopher Busuito, and Aimee Dereczyk

  Clozapine, a tricyclic dibenzodiazepine derivative, is an antipsychotic used in treatment resistant Schizophrenia to treat positive and negative symptoms of psychosis (1). It is also used for reduction in the risk of suicidal behavior in individuals with Schizophrenia and Schizoaffective disorders (1). However, it is a medication that is often used after trials of other antipsychotics have failed due to the concerns related to side effects. Some common side... Read More

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  Morphea Affecting Bilateral Ankles

  Katherine Kloberdanz and Chris Olenech

  Clinical Presentation: 65-year-old female with past medical history of diabetes, hypothyroidism, and arthritis presented to the podiatry clinic on 12/21/2018 complaining of increased swelling, pain, and skin darkening to bilateral dorsal ankles and stiffening of her ankle joints for two months. Patient also had multiple hyperpigmented firm plaques on her back, neck, and all four extremities. Patient had recently been seen by her rheumatologist. Lab work from that visit... Read More

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  Tender Erythematous and Necrotic Papules in a Young Pregnant Woman

  Sasank Konda, Vignesh Ramachandran, and Chauncey A. McHargue

  Patient History & Physical: A pregnant 21-year-old African American female (G5P2, 34w2d) presented with one day of painful, red bumps of her upper and lower extremities. Associated symptoms included chills, malaise, headache, photophobia, phonophobia, and edematous arthralgias (left shoulder, left ankle). Personal and family history were negative for thromboembolic phenomena, autoimmune disorders, or coagulopathies. She denied intravenous drug use, new sexual partners, blood transfusions, sick contacts, or recent travel.... Read More

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  Spontaneous Coronary Artery Dissection

  Michael P. Kostiuk and John Bauer

  Spontaneous carotid artery dissection (SCAD) is a rare cause of myocardial infarction. It occurs more commonly in younger, female patients. SCAD is non-traumatic and non-iatrogenic. Most patients that experience SCAD do not have typical risk factors associated with CAD. Conditions that pre-dispose patients to SCAD includes postpartum status, multiparty, connective tissue disorders (Marfan, Ehlers-Danlos), systemic inflammatory conditions or hormonal therapy. Although rare, labor and delivery can be a cause... Read More

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  A Tale of Two NETs: A Pheochromocytoma Masquerading as a Pancreatic NET

  Adam A. Kudirka and Nino Balanchivadze

  Introduction: Neuroendocrine tumors (NETs) are rare endocrine neoplasms with myriad of clinical manifestations. We present a case of two different NETs in a patient to increase physician awareness and highlight the importance of prompt multidisciplinary approach to avoid catastrophic complications.

  Case Presentation: A 58-year-old female with history of hypertension, diabetes mellitus and gastroesophageal reflux was referred to an oncology office for systemic therapy regarding suspected metastatic pancreatic neuroendocrine tumor... Read More

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  Pembrolizumab (Keytruda®) Associated Diabetic Ketoacidosis in a Previously Nondiabetic Patient

  Han Lam, Jason Rosner, Misha Masumy, and Ashish Verma

  Immune checkpoint inhibitors have been shown to be an essential part of cancer treatments, however there have been reported immune related adverse events. Type 1 diabetes was reported in only 0.1% of the patients in clinical trials of Pembrolizumab, a programmed cell death 1 (PD-1) inhibitor. We present a case of pembrolizumab associated DKA in a previously nondiabetic. Patient is a 75yo male with a history of carcinoma in... Read More

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  Primary CNS Melanoma

  Kevin Leikert, Shravani Mikkilineni, and Barry Skarf

  A 49-year-old female was referred to Neuro-Ophthalmology for evaluation of bilateral disc edema associated with headache. On initial presentation she was found to have a constricted visual field in her left eye and evidence an atrophic optic disc in the right eye and optic disc edema in the left eye. Evaluation with MRI showed no evidence of a mass lesion and lumbar puncture showed an elevated opening pressure leading... Read More

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  A case of Rhizopus infection in an immunocompetent IVDA host

  Tessa Lewitt and Anirudha S. Rathnam

  Introduction: Mucormycosis is a rare fungal infection most commonly seen in patients with neutropenia, diabetic ketoacidosis, or prolonged use of corticosteroids. Here we present an unusual case of isolated cerebral mucormycosis in a young, immunocompetent patient.

  Case: A 36 year-old female with chronic Hepatitis C and intravenous drug abuse (IVDA) presented with sudden hemiparesis of the left upper and lower extremities. Her Glasgow Coma Scale was 15. MRI brain... Read More

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  C3 Glomerulonephritis: A Rare Case of GN

  Stanley Linder and Hesham Shaban

  C3 Glomerulonephritis has undergone a recent change in its definition since its consensus review in 2013. Prior to 2013, C3GN would have been classified as a Type 3 Membranoproliferative Glomerulonephritis with the classic pathologic feature of double contoured Basement membrane which is notable in all MPGN types. It is relatively rare phenomenon affecting 1-2/1,000,000 cases in the US, based on registry data. A 71 year old woman with a... Read More