Case Reports

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Vaping Associated Lung Injury Requiring Bilateral Lung Transplant in an Adolescent

Neo Poyiadji, Gauravi K. Sabharwal, Jessica Leschied, Karyn Ledbetter, Denise Collins, and Thomas Song

Purpose: E-cigarette, or vaping, product use associated lung injury (EVALI) is a newly recognized entity that is being reported with increasing frequency in the literature and mainstream press. The aim of this case report is to radiographically illustrate the fairly rapid progression of a severe case of EVALI that ultimately required a successful bilateral lung transplant, and to describe a unique histopathology correlation.

Case Report: Our patient is a... Read More
Amyloid Got Your Tongue? Multiple Myeloma Presenting as Progressive Dysphagia

James P. Purtell

A 71 year old patient with a past medical history relevant for stage 3 chronic kidney disease attributed to hypertension and insulin-dependent diabetes presented to an outpatient swallow study ordered by their PCP due to a multi-month history of dysphagia, beginning with difficulty tolerating solids and worsening to inability to tolerate any solid or liquid oral intake or clear secretions. This was associated with a ~50 pound weight loss.... Read More
Delaying escalation of care for a COVID-19 patient

Nikola Rakic, Raef Fadel, Odaliz Abreu-Lanfranco, Indira Brar, and Geehan Suleyman

Background: Since being reported on December 31st 2019, COVID-19 has become a pandemic. In Detroit, there are 1075 cases and 23 deaths, as of March 28th, 2020. Rapid identification of the disease is vital as preliminary reports show that multiple ED and clinic visits are associated with worse outcomes, likely due to delayed treatment. Our report describes the course of a COVID-19 patient who required multiple visits prior to... Read More
Disseminated non-segmental vitiligo with halo nevi and grey hair

Vignesh Ramachandran, Katelyn Kim, Chelsea Fidai, and Lisa B. Zhang

HISTORY: A 20-year-old male with history of narcolepsy presented to the dermatology clinic for 5-month history of asymptomatic light spots on his trunk and graying of his hair. He initially noted acute onset of light spots slowly enlarging around moles on his chest and abdomen. Three months later, he developed slowly enlarging light spots disassociated with moles on his back and grey hairs on the back and top of... Read More
Born to Bleed: Fatal Intracranial Hemorrhage in a Patient with a Rare Sickle Cell Variant

Aula Ramo, Sophia Binz, and Muhammad Usman

Case: The patient is a 25 YO African American male with S/Oarab sickle cell anemia who presented with an acute, severe headache, extremity pain, and hallucinations. He presented distressed and tearful, stating that his pain was 10/10. His initial vitals showed that he was afebrile (36.5F), normotensive (123/83), with a heart rate of 71 bpm, a respiratory rate of 18 bpm, and a saturation of 96% on room air.... Read More
Foix Alajouanine Syndrome Mimicking Longitudinally Extensive Transverse Myelitis

Anirudha S. Rathnam, Iram Zaman, and Anza B. Memon

Objective: To describe an interesting case of Foix-Alajouanine Syndrome presenting as a longitudinally extensive transverse myelitis (LETM).

Background: Foix-Alajouanine Syndrome is caused by a spinal dural arteriovenous malformation and presents as paraparesis and progressive walking impairment. It most commonly involves the thoracolumbar region and affects elderly men. Though treatable, it is a cause of progressive myelopathy often misdiagnosed or missed.

Case Discussion: A 77-year-old man with a history of... Read More
How Anchoring Can Sink The Ship

Rita Rehana, Jay Patel, and Najia Huda

Introduction: Anchoring bias is a type of heuristic that uses an initial source of information as an “anchor” for basis of decision making. Then judgments and thought processes are led by this sole foundation. There are many different types of influences and bias used in medical decision making, which has prompted concerns regarding their impact on diagnostic inaccuracies. Studies have identified “anchoring” conducted in medical literature, clinical vignettes and... Read More
Severe COVID 19 Case with Atypical Presentation

Collin Richards, Raef Fadel, Odaliz Abreu-Lanfranco, Indira Brar, and Geehan Suleyman

Introduction: COVID-19 was brought to the attention of the WHO on December 31st, 2019 and classified a global pandemic on March 11th. As of March 26th, there were 2,856 cases and 60 deaths in Michigan, with 851 cases and 15 deaths in Detroit. Efforts to characterize risk factors for severe disease may improve clinical outcomes and inform resource allocation. Better understanding of the epidemiological and clinical characteristics of COVID-19... Read More
Bilateral Atypical Femur Fractures as a Presenting Manifestation of Unrecognized Hypophosphatasia

Tamara Roumayah Ivers, Leika Raychouni, and Sudhaker D. Rao

Introduction: Hypophosphatasia (HPP) is a rare inherited disorder of the ALPL gene which leads to decreased alkaline phosphatase (ALP) activity. Though severe symptoms are seen in childhood, adult HPP is milder and often asymptomatic except for low bone density, thus frequently escapes diagnosis. Hallmarks of adult HPP include decreased ALP, non-traumatic fractures or pseudo-fractures, and premature loss of teeth.

Case: A 56 year old previously healthy man presented for... Read More
A Robust Case of Allergic Contact Dermatitis to Propolis

Ethan Sagher, Holly Kerr, and Henry W. Lim

Allergic contact dermatitis (ACD) occurs when an individual comes into cutaneous contact with a substance to which he or she has been sensitized to, causing a delayed-type hypersensitivity reaction. While the diagnosis may in some cases be easily suspected due to a classic history and exam, not all cases are obvious. Patch testing is an extremely useful process that allows for the diagnosis of ACD to be made while... Read More
Thrombotic Thrombocytopenic Purpura Presenting as an Acute Coronary Syndrome

Omar Sallam, Mustafa Mohammed, and Layan Elkhatib

Introduction: Thrombotic thrombocytopenic purpura is a thrombotic microangiopathy caused by severely reduced activity of the von Willebrand factor-cleaving protease ADAMTS13. It is considered a medical emergency and could be fatal if appropriate medical management if not initiated in time. Rarely, it can present as an acute coronary syndrome.

Case presentation: We present a case of an 80-year-old female with a past medical history of hypertension and irritable bowel syndrome... Read More
Correlations between a history of gastric surgery and gastric carcinoma

Sruthi Sathyakumar and Sophia Binz

Case Report: Sleeve gastrostomies have become a common bariatric procedure in the increasingly obese population of the United States with more data now being reported on the complications and post-operative risks. Developing gastroesophageal reflux disease (GERD) and gastro-esophageal malignancies after bariatric surgery is a concern that has been reported in the literature; however, there is not enough data on this topic. We present a case of a 66 year... Read More
Hypercalcemia in renal transplant patient with Pneumocystis jirovecii pneumonia

Crystal Seudeal, Hafsa Adbulla, Vidhya Nair, Maryam Alimirah, and Geneva Tatem

Pneumoncystis jirovecii (PJP) is an opportunistic infection that can occur in immunosuppressed patients, including those with renal transplant. We present the case of a 63-year old male with autosomal-dominant polycystic kidney disease with renal transplant on immunosuppressive therapy who presented with cough and exertional dyspnea. He was hypoxic with coarse breath sounds bilaterally. CT chest revealed ground-glass opacities with increased interstitial markings of the left lung. Labs were significant... Read More
LADA presenting as hyperglycemic coma

Shivani Sharma, Taha Ashraf, Nitesh Gandhi, and Avi Cohen

Latent Autoimmune Diabetes in Adults (LADA), is considered a rare subset of Type 1 Diabetes Mellitus. These adults do not require insulin at diagnosis but progress to insulin dependence in a short period of time. Because of this the diagnosis is often missed and can result in potentially fatal complications such as Diabetic Ketoacidosis (DKA. Our case highlights one such example with extreme levels of hyperglycemia of 2345mg/dl and... Read More
Pandemic Emergency Department Triage Screening: Symptoms Increase Sensitivity

Aaron Sherwood, Tessa Lewitt, Raef Fadel, Joseph B. Miller, Geehan Suleyman, Odaliz Abreu-Lanfranco, and Indira Brar

INTRODUCTION: In the weeks following the January 20, 2020, announcement of the first confirmed case of COVID-19 in the United States, valuable data was published on the clinical characteristics, including the most common presenting symptoms of individuals affected with the disease. One study in Wuhan, China, identified fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%) as common symptoms. A second study in Washington State identified shortness... Read More
Atypical Presentation of COVID-19 causing Rhabdomyolysis: a case report

Gulmohar Singh-Kucukarslan and Danielle Heidemann

An otherwise healthy 42-year-old male presented with lower back pain and thigh pain. On presentation, he was found to have a CPK of 4100 and a creatinine of 2.99 (baseline 1). Lumbar x-ray was negative for an acute process. Urine drug screen was negative. However, repeat CPK revealed a CPK of 313,000 and a creatinine of 4.11. Upon further questioning, the patient denied any sort of trauma or injury.... Read More
Viral Hepatitis in COVID-Era

Lovepreet Singh, Jordan Siu, Arsalan Abbasi, and Ramanpreet Bajwa

The novel SARS-CoV-2 which originated in Wuhan and has spread worldwide is well known to cause severe acute respiratory syndrome. The most common clinical presentations that patients exhibited are fevers, shortness of breath, cough, diarrhea, loss of smell/taste. However, this virus has also been observed to cause multi-organ failure. We present the case of a 44yo F with a PMHx of GERD, Hashimoto’s thyroiditis, obesity, HTN, and neuropathy who... Read More
Severe Pre-Eclampsia in the Setting of COVID-19 Case Report of Three Patients in Detroit, Michigan

Amneet Sran, Tra V. Pham, and Quoc V. Le

This case series discusses three patients who presented to our institution with elevated blood pressures and respiratory complaints to demonstrate the complexity of delineating the diagnoses.
Hemoperitoneum: Beyond Trauma

Vladimir Starcevic, Matthew Rheinboldt, and Michael Hong

The causes of hemoperitoneum are numerous and evaluation by the radiologist and clinician team is critical as active hemorrhaging into the peritoneal cavity can be life threatening but if quickly recognized, may be urgently repaired. History and imaging clues usually rapidly narrow the differential in the atraumatic setting. In this representative pictorial review, we show various cases of hemoperitoneum on multiple imaging modalities, with an emphasis on CT. Cases... Read More
Anomia in a Lung Transplant Recipient

Natalie Stec and Stephanie B. Tancer

Progressive multifocal leukoencephalopathy (PML) is a rare, fatal sub-acute demyelinating disease of subcortical white matter most commonly caused by reactivation of the ubiquitous Jon Cunningham virus (JCV). PML has been documented in patients with immune-suppressed conditions, including but not limited to organ transplantation, HIV/AIDS, malignancy, and auto-immune diseases. We describe the case of a 65-year old male who presented with anomia, confusion, left upper extremity tremor, and generalized weakness... Read More
Not Just An Ankle Sprain

Anthony C. Tam and James Moeller

49-year-old male with past medical history of hypertension who presents to the sports medicine clinic with a five-year history of left lateral foot pain.
A unique presentation of Cryptococcus neoformans and Pneumocystis jirovecii PJP ) co infection in a newly diagnosed HIV patient

Zain Tariq, Shereen Zia, Daniel Schultz, Indira Brar, and Robert J. Tibbetts

One week prior to demise, a 30 years old smoker male with a past medical history significant for intermittent asthma presented to emergency with shortness of breath, wheezing, productive cough, and generalized fatigue for 1 week. He was afebrile, normotensive, tachycardic and had O2 saturation of 96% on room air. Physical examination showed cachexia, audible wheezes and oropharyngeal erythema. Labs showed WBC 3600/uL with lymphocyte count of 700/uL and... Read More
Renal Cysts in an Immigrant Patient: An Atypical Presentation of Echinococcosis

Bhavana Tetali, Daniel C. Grahf, Elian D. Abou Asala, and Daniel Axelson

Introduction: Cystic echinococcosis (CE) is an infection caused by the Echinococcus tapeworm that results in the creation of cysts within a range of visceral organs. Ninety percent of these cysts are in the liver or lungs. In the United States, cases are quite rare and most are found in immigrants from endemic countries. Patients with CE may remain asymptomatic for years. If left undiagnosed and untreated, mortality from CE... Read More
Placenta Percreta; A Report On Surviving Death From The Bleeding Disaster!

Jane N. Tolson, Sanchit Ahuja, Michael Isley, Ami Attali, and Joshua Younger

A 34 year old G6P5 diagnosed with placenta previa percreta (fig 1) in her 2nd trimester was reviewed by a multidisciplinary team. Baby delivery was planned at 34 weeks gestation by cesarean hysterectomy(CH) immediately preceded by bilateral ureteral stents for anticipated surgical complexity. Patient received combined spinal and epidural (not activated) for the ureteric stenting with an aim to use the epidural for post-operative analgesia followed by general anesthesia... Read More
Placenta Percreta: A Report On Surviving Death From The Bleeding Disaster!

Jane N. Tolson, Sanchit Ahuja, Michael Isley, Ami Attali, and Joshua Younger