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Relevant diagnostics and physical examination data. (A) Initial electrocardiogram on presentation to the critical care unit. (B) Still image of clonus on physical examination (refer to supplementary materials for video). (C) Electrocardiogram on discharge after successful treatment of serotonin syndrome.

Serotonin Syndrome Masquerading as Ventricular Tachycardia Storm

A 60-year-old woman with bipolar disorder presented to a local hospital after being found unresponsive at home. When assessed by emergency medical services, she was found to be tachycardic to 180 beats per minute and received 3 doses of adenosine on transport with no effect. Given concern for altered mental status, she was intubated for […]

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Apical 4-chamber view of the cardiac metastasis in the right ventricle.

Intracardiac Metastasis as the Initial Presentation ofNon–Small Cell Lung Cancer

Cardiac tumors have generally been considered to be rare. They are often found incidentally, as they tend to remain clinically silent, but they can sometimes present with symptoms secondary to obstruction, embolization, or invasion of the myocardium. Most cardiac tumors are secondary tumors from metastases, with primary cardiac tumors constituting approximately 15% of all cardiac […]

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(A) Inferior vena cava-right atrium thrombus. (B) Right atrium thrombus. (C) Right atrium thrombus.

An Oscillating Thrombus Inside the Inferior Vena Cava

Thrombosis of the inferior vena cava is an under-recognized entity that is associated with significant morbidity and mortality.1 It is estimated that 2.6%-4% of patients with deep vein thrombosis of the lower extremities have inferior vena cava thrombosis. The most common cause of inferior vena cava thrombosis is the presence of an unretrieved inferior vena cava […]

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Progressive Dysphonia: Ortner Syndrome

A 68-year-old woman with known idiopathic heart failure and severe reduced ejection fraction was admitted for aggravation of dyspnea and recurrent dysphonia over the past 6 months, progressing to constant hoarseness. Vitals signs were normal. Laboratory tests showed normal hemoglobin and white blood cell count, increased levels of N-terminal pro-brain natriuretic peptide (NT-proBNP; 10574 pg/mL), […]

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Swelling at the periorbital area (A). Extraocular muscle swelling (arrow head) in computed tomography (CT) (B). Positron emission tomography (PET) showed increased 18-fluorodeoxyglucose uptake (arrow head) at orbital (C) and hilar area (D).

Swollen Extraocular Muscle and Tingling Extremities

A 55-year-old man with a 3-month history of numbness and tingling in his extremities presented at a hospital. After obtaining a diagnosis of seronegative arthritis, the patient underwent immunosuppressive therapy with prednisone (5 mg/day) and salazosulfapyridine (100 mg/day). However, the symptoms did not improve, and he later experienced double vision. After 10 days, the patient […]

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Computed tomography of the chest demonstrated bilateral pulmonary nodules.

Not All It’s CrAged Up to Be: Disseminated Cryptococcosis

Phenomena known as cognitive biases, when applied to the details of a patient’s medical history, evidently steered the first attempts at diagnosis in the wrong direction. A 60-year-old man presented after 6 weeks of progressively worsening fevers, weight loss, malaise, night sweats, and confusion. Originally, the fevers were intermittent and low grade at 37.7°C (99.9°F). […]

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