A 79 year-old African American lady presented to the emergency department with complaints of dyspnea which followed the second application of her recently prescribed eye drops (timolol 0.25% ophthalmic solution). She had been taking azythromycin for an upper respiratory infection as well. However, she had taken this antibiotic in multiple occasions in the past. She denied any other medications or recent trauma to the oral cavity. The patient was admitted to the intensive care unit and emergently intubated via the nasotracheal route.

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A middle age Caucasian gentleman presented to the Emergency Department with fever, chills and hypotension. Chest X-ray revealed consolidation in right lower lobe consistent with pneumonia. A chest radiograph after central line placement revealed a venous anomaly. CT scan with contrast revealed persistent left superior vena cava and absent right superior vena cava.

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We present the case and images of a 52 yearold Hispanic gentleman with a history of hepatitis C and chronic liver disease that developed Vibrio vulnifi cus sepsis secondary to eating raw oysters.
His course was complicated by necrotizing fasciitis in the upper extremities and renal failure.

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Clinical presentation of miliary tuberculosis is highly variable. Patients that present with central nervous system disease such as meningitis or tuberculoma is seen in up to 20% of the cases. Meningeal involvement is usually seen in up to 54% of the cases of miliary tuberculosis, and in just a few minority of patients the AFB smears are positive.

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A 59 year-old lady with a history of diabetes,
hypertension, and coronary artery disease presented to
the emergency department complaining of progressive
shortness of breath over a 6 month period. On initial
examination she was found to be hypoxemic with a
PaO² of 50 mmHg. A chest radiograph left lower lobe
consolidation (Figure 1). The patient was given broadspectrum
antibiotics and admitted to the intensive care
unit (ICU). In the ICU she remained on antibiotics
and bronchodilator therapy was started. Despite these
interventions, she showed no evidence of improvement

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A 48 year-old Hispanic gentleman presented to the emergency department (ED) with 2-hour history of acute dyspnea. The patient had the history of motor vehicle accident 15 years prior to presentation. A chest x-ray done in the ED revealed pneumothorax and hydrothorax in the left chest. The patient had emergency closed tube thoracotomy with resolution of the pneumothorax. The chest tube began to drain fecal contents.

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