- A 62-year-old woman presented to an outside emergency department with a 24-hour history of vomiting-associated chest pain. She described a nonradiating retrosternal ache with dyspnea and diaphoresis after multiple episodes of nonbilious and severe vomiting. Recent history was notable for amoxicillin/clavulanic acid–treated colitis. After failure to improve, she was diagnosed as having Clostridium difficile and completed 10 days of treatment with vancomycin. Two weeks prior to presentation, fidaxomicin was initiated because of persistent symptoms and ongoing stool positivity.
- A 71-year-old man with a history of hypertension, hyperlipidemia, and bicuspid aortic valve endocarditis treated with prosthetic valve replacement in 2012 presented to the internal medicine clinic for his annual physical examination. His home medications included aspirin (81 mg), pantoprazole (40 mg), paroxetine (37.5 mg), rosuvastatin (20 mg), and terazosin (10 mg) daily. Review of systems was notable for increasing exertional and supine shortness of breath. He also reported occasional chest discomfort on the right side with and without exertion.
- A 39-year-old woman presented to the emergency department (ED) with progressive weakness. Her medical history was notable for iron deficiency anemia, gastroesophageal reflux disease (GERD), and obesity after Roux-en-Y gastric bypass 10 years previously. Active home medications included omeprazole (40 mg daily) and 2 recent intravenous (IV) infusions of ferumoxytol (510 mg elemental iron per dose). Several months prior to her ED presentation, the patient experienced tingling in both hands and feet, new-onset dyspnea with climbing stairs and sexual activity, and intermittent episodes of fatigue, which gradually increased in frequency and severity.
- A 65-year-old man, a nonsmoker, presented to the hospital in mid-February 2021 with a 30- to 40-lb weight loss over 2 to 3 months and profound fatigue. He also endorsed dyspnea on exertion, a productive cough, and profuse watery diarrhea for several days. Clinical comorbidities included a diagnosis of Mantle cell lymphoma (MCL) in remission after treatment with chemotherapy (cyclophosphamide, vincristine, doxorubicin), autologous stem cell transplant (ASCT) in May 2019 and maintenance rituximab every 8 weeks, hypogammaglobinemia, hypertension on lisinopril, type 2 diabetes mellitus (T2DM) on metformin, and coronary artery disease on aspirin and atorvastatin.
- A 43-year-old woman with a medical history of stage IIIB cutaneous melanoma previously receiving adjuvant immunotherapy with nivolumab presented to the emergency department with a 4-day history of nausea, vomiting, abdominal pain, and jaundice. Symptoms began with nausea and vomiting after eating a meal. The following morning she had dull right upper quadrant and periumbilical abdominal pain. Her nausea persisted, and she had multiple episodes of nonbloody nonbilious emesis. Later that day, she developed jaundice and had fever and chills, which prompted her presentation to the emergency department.
- A 24-year-old woman with a complex medical history including Ehlers-Danlos syndrome with hypermobility subtype, mast cell activation syndrome, eosinophilic esophagitis, and postural orthostatic tachycardia syndrome (POTS) presented to the emergency department (ED) for evaluation of menorrhagia, muscle cramps, and fatigue of 3 weeks’ duration. Her home medications included albuterol (90 μg/inhaler to be used every 6 hours as needed), cyanocobalamin (1000 μg daily), diphenhydramine (50 mg twice a day), epinephrine (0.3 mg/0.3 mL by auto-injector as needed), fexofenadine (180 mg twice a day), ketotifen (2 mg twice a day), and montelukast (10 mg daily at bedtime).
- A 69-year-old man presented to the emergency department (ED) with new-onset dysuria, urinary frequency and urgency, and right lower quadrant abdominal pain of 5-hour duration. His medical comorbidities included benign prostatic hyperplasia, obesity, hypertension, and hyperlipidemia. He also noted nausea and 3 episodes of nonbloody, nonbilious emesis. For the past week, he reported severe colicky right flank pain, which he attributed to musculoskeletal pain, that was partially relieved by taking no more than 1 tablet of an over-the-counter nonsteroidal anti-inflammatory drug daily.
- A 47-year-old man with no significant past medical history presented to the emergency department with sudden-onset palpitations. He denied any recent fevers, chills, or unexpected weight loss. He had no recent sick contacts and no pertinent travel. He reported moderate alcohol intake, did not smoke, and was not on any medications at the time.
- 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.