The American journal of emergency medicine
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Psoralen plus ultraviolet light therapy (PUVA) combines the administration of psoralen with an exposure to ultraviolet A radiation. Psoralen plus ultraviolet light therapy is used for the treatment of a variety of skin diseases including morphea and generally considered as a safe treatment modality. We present here a rare case of 65-year-old woman presented with acute myocardial infarction following PUVA session, which has not been reported previously.
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Case Reports
Vogt-Koyanagi-Harada disease: presentation and implications in undocumented immigrants.
Vogt-Koyanagi-Harada syndrome is an autoimmune disease involving pigmented tissue in the eyes, auditory system, skin, and central nervous system. It often presents as bilateral chronic granulomatous panuveitis. We report the case of a 32-year-old immigrant who presented to the emergency department asking for a second opinion for loss of vision and progressive hearing loss. We also will discuss the issue limited access to health care for a vulnerable population such as undocumented immigrants.
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Medicaid enrollees are disproportionately represented among patients with frequent Emergency Department (ED) visits, yet prior studies investigating frequent ED users have focused on patients with all insurance types. ⋯ One out of 8 Medicaid enrollees who visited the ED had ≥4 visits in a year. Efforts to reduce frequent ED use should focus on reducing barriers to accessing primary care. More tailored interventions are needed to meet the complex needs of adults with ≥18 visits per year.
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Anisakiasis, a parasitic infection by larvae of the nematode Anisakis found in raw or undercooked saltwater fish, mostly involves stomach but rarely small intestine. We report a rare case of a 61-year-old man who presented with abdominal pain and developed small bowel obstruction caused by intestinal anisakiasis. Abdominal computed tomography revealed segmental edema of the intestinal wall with proximal dilatation. ⋯ It is often clinically challenging to consider intestinal anisakiasis in the differential diagnosis because of its nonspecific abdominal symptoms and findings. Although gastrointestinal anisakiasis is still rare in the United States, the incidence is expected to rise given the growing popularity of Japanese cuisine such as sushi or sashimi. Anisakiasis should be considered as one of the differential diagnoses in patients with nonspecific abdominal symptoms after consumption of raw or undercooked fish.
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We present a case of a patient presenting with posterior reversible encephalopathy syndrome to the emergency department. We discuss the various symptoms that lead to the identification of posterior reversible encephalopathy syndrome and the important clinical clues. Posterior reversible encephalopathy syndrome is a very uncommon diagnosis/clinical presentation that requires the understanding of the condition and awareness in distinct/specific patient populations. Without this understanding, the diagnosis may be missed and appropriate management delayed.