By: Mirelle Alktaish, Jesse Lamb, Jamesetta Polahn, ,Ilana Nathan, Hawraa Beydoun, Arielle Preston This case discusses the findings of a 5-month-old Hispanic male, who initially presented with 5 days of fever, 3 days of diarrhea and rash, and 2 days of vomiting. He had been diagnosed with acute otitis media by his primary care physician 3 days prior to his presentation and started on amoxicillin. He was brought to the ED because of his persistent fever up to 104°F and decreased oral intake. At the time of presentation, there were multiple entities in the differential diagnosis including meningitis, acute gastroenteritis, … Continue reading PIG: The Heart of the Matter: Fever of Unknown Origin

By: Emily Millet, Heygaan Rajakumar, Jesse Lamb, Brad Trent, Akshata Gailot, Tiffany Golek A 51-year-old female presented with sinus pain to her dentist, who incidentally found the patient had a left-sided blocked maxillary sinus via a computed tomography scan. She was referred to an otolaryngologist.  Patient had a chief concern of pressure and discomfort in the left cheek.  Patient reported the duration of this discomfort as approximately 1 year with no additional complaints nor changes in smell or rhinorrhea.  Upon examination, the physician noted a change in eye position.  Physical exam revealed enophthalmos of the left eye with normal extraocular … Continue reading SIG: Silent Sinus Syndrome

By C. Dixon, J. Benalcazar, K. Bourgeois, A. Cheng, N. Isic, J. Yelena Imele Itjoko 7-year-old African-American male brought to ED by his mother with peeling rash to face, axilla, and groin, onset one day. Mother reported abdominal pain, nausea, and three episodes of vomiting for two days prior, and decreased urine output from umbilical urostomy, which appeared in well-cared for condition. Patient afebrile on arrival, tolerating oral fluids only. Historyincluded obstructive uropathy with posterior urethral valves removed, stage 3 chronic kidney disease (CKD), and neurogenic bladder. Prior hospitalization for urosepsis and fecal impaction, with surgical intervention after colonoscopy revealed embedded glass, carpet, nail clippings, and pistachio shells in rectal wall, … Continue reading 7 Year Old Male’s Condition in Hot Water: Bacterial, or More Sinister Origin? A Burning Question.

By Latoya Alexia Bethell, Nelofer Jawadi, Andrea Davila, Sarah Alzaroui, Vernee Labega, Marylynda Ogbudinkpa A previously healthy 3-week-old girl presented to her pediatrician with lesions on her forehead and perianal region, with no fever or purulent drainage. Additionally, she developed a mild nasal congestion and irritability, but no further symptoms. After evaluation, the infant was referred to the Pediatric Emergency Department for a neonatal sepsis work-up with high suspicion of HSV infection. Her mother had a history of genital warts. At time of presentation, the neonate had no hepatosplenomegaly, lymphadenopathy, or rash anywhere else, and presented with normal tone, strength, … Continue reading Neonatal Rash, to Swab or Not to Swab

By Isabella A. Reichard Manrique, Dean Alessi, Dorothy Juliet Benonaih-Jumbo, Sarah Moore, Mabel Okoampah, Michael Davry A 60 year-old male with diabetes and HTN presents to the Emergency Department with progressively worsening right foot pain for the past three to four days. The patient is a heavy smoker; one pack of cigarettes per day for 20 years, and has a past medical history of CHF s/p surgical implantation of a cardioverter defibrillator, CAD, and stroke with a past surgical history of a cardiac angiogram with stent placement. Patient’s heart rate and rhythm were normal. Doppler assessment detected posterior tibial and … Continue reading Treatment of necrotizing soft tissue in diabetics: The guillotine

Authors: Fadi Ali Jamaleddin Ahmad1, MPH., BS, Nukhba Syed1, BS, Meghan Mangal1, BS, Kirstie Venegas1, Emily Dill1, and Maryna Al-Fauri1, MD., PhD. Affiliation: American University of the Caribbean Medical School1 A 2 y/o F UTD on vaccinations with no past surgical history, hospitalizations, or family hx presents to the emergency department with her mother for abdominal pain with associated vomiting. The patient was found to be febrile (39.9C) and hypotensive (100/77) with a lethargic appearance and an acutely tender abdomen. Two days ago the patient had one episode of emesis and yesterday her mother noted that she was walking with … Continue reading Acute appendicitis coexisting with acute pyelonephritis causing diagnostic dilemma in a pediatric patient: a case report

Authors: Fadi Ali Jamaleddin Ahmad1, MPH., BS, Latoya Alexia Bethell1, MS., BS, William Hunt1, MDiv., BA, and Athena Andreadis1, MD.  Affiliation: American University of the Caribbean Medical School1 Abstract:  A 64-year-old male and long-term smoker with a history of COPD, chronic respiratory failure on continuous home oxygen at 4L nasal cannula for the past 6 months presents to the Emergency Department with new-onset chest pain for the past 12 hours. Vital signs: T 98.6 F, BP: 98/62, HR: 110, RR: 23, and O-S: 90% on 6L non-rebreather and EKG showing diffuse ST elevation. He has been seeking experimental treatments for … Continue reading Case Study: Stage 4 Non-Small Cell Lung Carcinoma and Ethical Decision for Palliation Care

By Jessica Jahoda, Corey Steinman, Jonathan Kwok, William Duggan, Tyler Price, Brant Grisel An eleven-year-old girl with an unremarkable medical history presents with severe right knee pain after falling from a bike and landing on her flexed knee. She presented to the ER with swelling, severe tenderness along the knee joint, and a palpable gap at the inferior border of the patella. Intact skin in this area indicates no signs of open fracture. The patient had an extension lag of 35-40 degrees. Passive range of motion was preserved with pain throughout an arc of motion. No neurovascular deficit in the … Continue reading 1% pediatric fracture hidden in the sleeve