Legionella pneumophilia is a multi-systemic disease primarily affecting the pulmonary, gastrointestinal, and to a lesser extent, renal systems. We present a case of Legionella pneumonia, which after resolution of respiratory compromise, was complicated by the development of autoimmune hemolytic anemia (AIHA) as determined by a positive Coombs test, and negative workup of other causes. Steroid immunosuppression was initiated, and red cell counts subsequently improved. While AIHA has only been anecdotally described in one prior case, the separation in time of the development and resolution of respiratory symptoms with the development of anemia most likely makes this an under-appreciated entity. An in vitro mechanism has been suggested; however in vivo causation has yet to be proven. Given the prolonged deleterious clinical consequences associated with the development of AIHA and the increase in recognition of Legionella outbreaks, greater recognition of this potential complication and research into the pathophysiology is warranted for the future.

Diabetes mellitus can be associated with a variety of musculoskeletal conditions. These conditions mostly occur in longstanding and poorly controlled diabetes and are the result of progressive alterations in tissues. Timely recognition of these conditions is of paramount clinical importance as diabetes control helps in preventing progressive deformity and disability, pain control, and maintaining reasonable quality of life. In addition, some of these conditions can be addressed with available treatment modalities. We present a 43-year-old female with a longstanding history of type 1 diabetes mellitus admitted for diabetic ketoacidosis. She had a significant prior history of musculoskeletal conditions. Physical examination findings of her hands revealed thick and tight skin, sclerodactyly, and "prayer sign". Appropriate workup to rule out systemic and limited sclerosis was performed and was negative.

Pseudogout is a crystal-induced arthropathy characterized by the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in synovial fluid, menisci, or articular cartilage. Although not very common, this entity can be seen in patients with chronic kidney disease (CKD). Septic arthritis due to Mycobacterium avium-intracellulare (MAI) is a rare entity that can affect immunocompromised patients such as those with acquired immunodeficiency syndrome (AIDS) or those who are on immunosuppressive drugs. Here, we describe a 51-year-old female who presented with fever, right knee pain, swelling, warmth, and decreased range of motion for several days. The initial assessment was consistent with pseudogout, with negative bacterial and fungal cultures. However, due to high white blood cell (WBC) count in the synovial fluid analysis, she was empirically started on intravenous (IV) vancomycin and piperacillin-tazobactam and discharged on IV vancomycin and cefepime, while acid-fast bacilli (AFB) culture was still in process. Seventeen days later, AFB culture grew Mycobacterium avium-intracellulare (MAI), and she was readmitted for relevant management. This case illustrates that septic arthritis due to MAI should be considered in the differential diagnosis of septic arthritis in immunocompromised patients.

The authors report a case of a fifty-one-year-old man undergoing rehabilitation therapy following a stroke who suddenly developed right-sided pleuritic chest pain with dyspnea. Transesophageal echocardiography was used to demonstrate a nonocclusive right pulmonary artery embolus, when other investigative modalities failed to establish the diagnosis.