FOAMed

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EM@3AM: Splenomegaly

A 20-year-old female presents to the ED with “abnormal results” found on a CT scan. She was feeling well until approximately 2 weeks ago when she began to have fatigue, malaise, loss of appetite and abdominal discomfort. She saw her primary care doctor who ordered an outpatient CT scan of her abdomen and pelvis, and upon obtaining the results showing splenomegaly, sent her to the ED for evaluation.  What is the approach to the patient with splenomegaly? 

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EM@3AM: Monkeypox

A 26-year-old female patient comes to the ED with an 8-day history of progressive weakness, fevers, and body aches. She reports that 4 days ago she noticed “bug bites” on her face, neck, arm, and hands. Sixteen days ago, she returned from a trip to Los Angeles where she shared a bed with her friend who was ill and had a rash at the time. The patient’s medical history is unremarkable, and she takes no medications. She is in a monogamous relationship with her long-term boyfriend and uses condoms consistently. Her temperature is 38.1º C (100.6ºF). Examination shows bilateral anterior cervical lymphadenopathy, and the lesions appear to be papular in appearance. The lesion resembles others on her face, neck, right upper arm, and other hand.   What is the most likely diagnosis?

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