Multiple Myeloma (MM) is a plasma cell disorder characterized by abnormal proliferation of plasma cells resulting in overproduction of paraprotein. Proteasome inhibitors (PI) have been a corner stone for the treatment of MM. Thrombotic Microangiopathy (TMA) is a recent hematological adverse event that has newly been recognized in multiple PI. TMA leads to end-organ damage and infarction by microthromobi. TMA pathophysiology is not well understood and has multiple etiologies. We present a case of PI-induced TMA, along with literature review of cases diagnosed from 2008–2018. Unique to our case is the onset of presentation, more than 24 months after initiating carfilzomib. Our case highlights the need for vigilant monitoring and the importance of clinical suspicion in patients at risk for TMA.

Dietary Vitamin K is a well-known anti-hemorrhagic agent that plays an integral role in the coagulation pathway. Vitamin K is involved in synthesis of coagulation factors; II, VII, IX and factor X. Vitamin K deficiency leads to bleeding diathesis. Hemorrhages usually present in deep soft tissue, rather than mucosal or epithelial membranes, bleeding that is generally caused by disorders of platelets. Major causes of vitamin K deficiency include; medications and diseases involving fat metabolism with a resultant fat malabsorption. Warfarin and Cephalosporins are one of the commonly prescribed medications that lead to vitamin K deficiency. Disease affecting fat metabolism pathway, such as; diseases of the pancreas (cystic fibrosis), short gut syndrome and certain pathologies of the biliary tree. Vitamin K deficiency is more common in newborns. In adults it is uncommon because of its ubiquitous nature and the abundance of its sources. Hemorrhagic disorders in adults due to Vitamin K deficiency are not commonly encountered in practice. We are presenting a case of an adult who presented with a compartment syndrome secondary to a traumatic intramuscular bleeding. Our case highlights the importance of considering vitamin K deficiency in the differential diagnosis of unexplained hemorrhages resulting from a coagulopathy.

Chronic venous insufficiency (CVI) is a common condition characterized by lower extremity edema, discomfort, and skin changes due to venous hypertension caused by incompetent or obstructed venous valves. We report a case of chronic venous insufficiency and lymphedema with papillomatosis cutis lymphostatica, hyperkeratosis, and skin ulcers with proteus superinfection. A 67-year-old male presented to the emergency department (ED) for wound evaluation and was found to have severe hyperkeratosis, multiple ulcers with purulent discharge, and "tree bark" skin changes. Prophylactic treatment for deep vein thrombosis (DVT) was initiated, followed by successful surgical debridement. A subsequent diagnosis of Proteus mirabilis superinfection was treated accordingly. This report highlights the importance of adequate long-term management of chronic venous insufficiency as it may lead to serious complications.

Beer potomania is a unique condition characterized by hyponatremia secondary to excessive beer drinking and low daily solute intake. We report a case of a 41-year-old African American female with multiple comorbidities, notably alcohol use disorder, who was initially treated for hypertensive emergency and was subsequently found to be hyponatremic during the same visit. Beer potomania was suspected as a leading etiology of hyponatremia. This report emphasizes the importance of the proper diagnosis and appropriate management of beer potomania in the setting of concomitant comorbidities. Clinician awareness is crucial in implementing immediate treatment and in the prevention of potentially fatal sequelae such as severe malnutrition and osmotic demyelination syndrome.