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EM@3AM: Scleroderma and Severe Sequelae

A 45-year old African American woman presents with progressive fatigue over the past week and has experienced intermittent episodes of severe hand pain that typically self-resolve. She has also noted a worsening headache over the last day. Her blood pressure is 197/105 mm Hg and heart rate is 90 bpm. The physical exam is notable for smooth and taut skin on the patient’s face and hands. Laboratory values show a creatinine of 3.1 mg/dL. What is the likely diagnosis?

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EM@3AM: Meningococcal Disease

A 12-year-old girl presents to the ED with a 2-day history of headache and fever. The patient started vomiting with fevers this morning, and her mother was unable to wake her from her afternoon nap. She is lethargic and responds to painful stimuli with temperature of 38.2 C, blood pressure 88/65 mmHg, and HR 132 bpm. She has a petechial rash on her lower back and lower extremities, as well as resistance to neck flexion. What is the diagnosis?

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