Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2University of British Columbia, Vancouver, British Columbia, Canada
A 45-year-old man with a history of renal cell carcinoma (nephrectomy 2 years earlier) presents with subacute onset of asymmetric flaccid paraparesis with signs of pyramidal tract dysfunction, a sensory level at L2, and urinary retention.
A 59-year-old woman with metastatic breast cancer presents to the emergency department 2 days after beginning treatment with capecitabine with loss of coordination, acute confusion, and muscle weakness.
A 36-weeks' gestation female fetus is diagnosed with a mass protruding from the mouth.
A 23-month-old girl presents with lethargy, fever, and then altered mental status. She has a family history of maternal relatives who died of similar symptoms in childhood.
A 27-year-old man with relevant history of nephrolithiasis and minimally invasive parathyroidectomy several years prior presents with knee and hip pain, polyuria, polydipsia, and laboratory findings of recurrent primary hyperparathyroidism. Physical examination is unremarkable. Family history is positive for adrenal tumor, possibly a pheochromocytoma, in his father. Subsequent genetic testing, performed due to concern for multiple endocrine neoplasia–related disease, shows deletion of exons 4–6 in the CDC 73 gene.
A 6-month-old infant presents with a large swelling over the lower back that has been present since birth.
A 76-year-old man with refractory diffuse large B-cell lymphoma 1 month post CAR-T therapy presents with pancytopenia, aphasic speech, and left-sided hemiparesis.
A 56-year-old woman presents to the emergency department with aphasia and acute encephalopathy. Initial noncontrast head CT/CTP/CTA are all negative for acute infarction, hemorrhage, and major vessel occlusion. The patient then reports abdominal pain, experiencing both diarrhea and coffee ground emesis. Laboratory results yield findings consistent with renal failure and thrombocytopenia; stool analysis yields Shiga toxin.
A 30-year-old man with 2 days of headaches and malaise, is found down by roommate. In the emergency department, he is found to have altered mental status, mutism, fever, tachycardia, hypertension, rigidity, hyperreflexia, and a purpuric rash.
