- A 57-year-old man, originally from Burma, presented to the emergency department with headache, nausea, vomiting, and unsteadiness in December 2020. He had no significant medical history and was not taking any medication.
- A 37-year-old man with obesity and type 2 diabetes mellitus presented to his primary care physician with 4 days of headache, congestion, and nasal drainage. His headache was dull, aching, and involved his entire head, though there was an occasional throbbing quality pain in his bilateral cheeks (just below the eyes) and forehead. Nasal congestion was his most bothersome symptom, and he felt so “stuffy” that it was difficult to breath at night. He reported green drainage from the nose with brownish streaks.
- 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.