We describe a 6-year-old boy who presented to the emergency department with the complaint of nausea and vomiting with diarrhea. Workup revealed a glucose level of 1904 mg/dL, and hyperglycemic hyperosmolar syndrome was diagnosed. Hyperglycemic hyperosmolar syndrome is very rare in the pediatric population, but recent published reports suggest that the incidence of this disorder may be increasing.
We present a case of a 15-year-old girl who presented with 1 month of worsening nonpruritic rash limited to her palms and soles. She had been treated twice for sexually transmitted infections. With her presentation of a nonpruritic rash on the palms and soles, a diagnosis of syphilis must be considered.
Necrotizing fasciitis is uncommon in the United States. Despite medical advances, its mortality rate has remained unchanged over the past 20 years at 25% to 35%. Risk scoring tools have been created but often fall short when used in the clinical setting. We present a case of an elderly woman with necrotizing fasciitis but with extensive intraparenchymal air that is undocumented in the literature. Imaging demonstrated significant air collections originating from an infection on the right foot that extended through the body, including the cranial vault. Despite aggressive resuscitative efforts, the patient was not considered a surgical candidate and ultimately died. Using a scoring tool for our patient suggested a low probability of infection, demonstrating that clinical suspicion should take precedence over any test or scoring system.
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