Acute renal failure remains a significant concern in all patients with the coronavirus disease 2019 (COVID-19) infection. Management is particularly challenging in critically ill patients requiring intensive care unit (ICU) level of care. Supportive care in the form of accurate volume correction and avoiding nephrotoxic agents are the chief cornerstone of the management of these patients. The pathophysiology of acute renal failure in COVID-19 is multifactorial, with significant contributions from excessive cytokine release. Gaining a better insight into the pathophysiology of renal failure will hopefully help develop more directed treatment options. A considerable number of these patients deteriorate despite adequate supportive care owing to the complexity of the disease and multi-organ involvement. Renal replacement therapy is used for a long time in critically ill septic patients who develop progressive renal failure despite adequate conservative support. Timing and choice of renal replacement therapy in critically ill COVID-19 patients remains an area of future research that may help decrease mortality in this patient population.

Isotretinoin is a frequently prescribed medication for severe nodulocystic acne. It is also used in higher doses and other forms to treat some carcinomas. Pancreatitis remains a well-known but rare side effect of this medication. Two proposed mechanisms for pancreatitis are hypertriglyceridemia induced and idiosyncratic reaction. Here, we present a case of a young man who presented for the evaluation of abdominal pain. His blood work showed elevated lipase levels but computed tomography (CT) of the abdomen did not show any pancreatic inflammation.

Eosinophilic pneumonia comprises a group of lung diseases in which eosinophils appear in increased numbers in the lungs and sometimes in the bloodstream. Among several causes of pulmonary eosinophilia, drug-induced pulmonary eosinophilia and subsequent pneumonia is a well-known side effect of many medications. Daptomycin is now being increasingly recognized culprit medication in patients with eosinophilic pneumonia. Here we present a patient with daptomycin-induced acute eosinophilic pneumonia, who had an unusual response to usual treatment.

Anabolic-androgenic steroids (AAS) abuse is common in competitive athletes in order to enhance athletic performances. However, AAS abuse is often associated with deleterious side effects including but not limited to cardiovascular diseases, depression, hormonal abnormalities, and cancer. We present a case of a 31-year-old male with a history of Crohn’s disease on infliximab and chronic AAS use who had persistent retrosternal chest pain found to have an acute myocardial infarction (MI) without obvious cardiovascular risk factors.

Spontaneous pneumomediastinum is an uncommon diagnosis defined as the presence of free air in the mediastinum without an apparent cause. It is a self-limiting disorder that most often occurs in young males without any apparent precipitating factor or underlying disease process. Its pathophysiology involves the rupture of alveoli with resultant air penetration into the mediastinum. Underlying disease processes, such as asthma, physical trauma, including yelling, contact sports, and Valsalva during labor, have also been reported to cause spontaneous pneumomediastinum. Here, we present the case of an 18-year-old male who presented to us with the chief complaint of cough and the subsequent diagnosis of spontaneous pneumomediastinum.

Negative pressure pulmonary edema (NPPE) is a noncardiogenic-related rapid onset of bilateral pulmonary edema secondary to various etiologies that lead to upper airway obstruction. Despite the fact that it is more commonly seen in the emergency department (ED), pediatric intensive care unit (PICU), and the postanesthesia care unit (PACU), there is a lower disease prevalence in the medical intensive care unit (MICU) as it sometimes could be overlooked upon. Prompt treatment often leads to favorable clinical outcomes. We detail a 55-year-old lady with a past medical history of nephrolithiasis, obesity, and obstructive sleep apnea presented with right flank pain due to right kidney subcapsular hematoma and left hydronephrosis due to distal ureteral calculus requiring urological intervention. She unfortunately subsequently developed NPPE requiring MICU level of care after reintubation. Successful extubation was achieved two days later as timely recognition of NPPE led to proper treatment. She was downgraded to general medicine service and discharged without complications.