- A 28-year-old man presented to the emergency department with right shoulder pain that radiated to the right arm as well as pain of the right hip and lower back. His medical history is significant for sickle cell disease (SCD) with the HbSS genotype (homozygous for the S globin). He had a hemorrhagic stroke in the setting of venous sinus thrombosis 2 years earlier with no persisting neurologic deficits as well as osteonecrosis of bilateral hips and right knee requiring right total hip arthroplasty and right total knee arthroplasty.
- A 44-year-old male construction worker presented to the emergency department with a 1-week history of occipital headache associated with blurry vision, disequilibrium, and gait instability. His symptoms began with vision changes and headache and had progression to gait instability several days before presentation. The headache was rated as 7 out of 10 in severity, worsened with neck extension, and slightly relieved by neck flexion. He did not have any significant medical history and did not take any medications regularly.
- A 21-year-old black female with past medical history of deep vein thrombosis and anaphylaxis presented as a hospital transfer for a progressive vesicular rash. Three weeks before admission, she developed a midline facial pruritic, burning rash and arthralgias. She was pregnant during the initial rash eruption; however, she experienced a first trimester miscarriage and upper extremity deep venous thrombosis 1 week after rash eruption. At the time of admission to our hospital, her rash had progressed to involve the axillae, neck, trunk, arms, head, and oral and genital mucosa.
- A 48-year-old woman presented to the emergency department with a 3-week history of bilateral lower extremity paresthesias, weakness, and progressive dyspnea. Her symptoms began with numbness in her feet and gradually progressed proximally to involve her knees and hands. Eventually, progressive weakness developed in the same distribution. She had difficulty climbing stairs and going from a seated to a standing position. Her most recent symptoms included exertional dyspnea, now present at rest. She had not experienced diplopia, slurred speech, dysphagia, difficulty holding her head, or back pain.
- A 60-year-old woman presented with a 6-month history of progressive fatigue and frequent headache. The fatigue was worse in the afternoon and prevented the patient from performing her regular daily activities. She reported occasional blood-tinged urine and hematochezia, and no hematemesis or melena. Her medical history was notable for an unprovoked lower-extremity deep vein thrombosis (DVT) 1 year earlier, for which she had completed 6 months of warfarin therapy. Medications included omeprazole, zolpidem, and a daily calcium/vitamin D supplement.