Hashimoto encephalopathy (HE) is a term used to describe an encephalopathy of presumed autoimmune origin characterized by high titers of antithyroid peroxidase antibodies, an essential feature of this disorder. Pertinent laboratory findings include an elevated serum level of antithyroid peroxidase antibody (TPOAb) and/or antithyroglobulin antibody (TgAb) and negative autoimmune markers of encephalitis in cerebrospinal fluid (CSF). The analysis of CSF may show increased cellularity due to lymphocytic pleocytosis. However, there is no clear relationship between the severity of neurologic symptoms and the type or serum concentration of antibodies. Approximately two-thirds of patients of HE will experience seizures. Patients can present with a recurrence/remission or a diffuse, progressive pattern characterized by slowly progressive cognitive impairment with dementia, confusion, or hallucinations. We present a rare case of Hashimoto's encephalopathy associated with hyperthyroidism in a 61-year-old man evaluated for left facial droop and right upper extremity weakness, successfully treated with corticosteroids and methimazole. We conclude that the diagnosis of HE should be suspected early and be on the differential in patients who present with encephalopathy, which workup shows positive anti-thyroid antibodies and CSF with lymphocytosis. Treatment for meningitis or other life-threatening conditions should never be postponed, as HE is a diagnosis of exclusion that usually requires an extensive laboratory and diagnostic workup. Early diagnosis has an excellent outcome once treatment is started as it is a steroid-responsive encephalopathy associated with autoimmune thyroiditis. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Emphysematous pyelonephritis (EPN) is an acute life-threatening necrotizing infection of the renal parenchyma and perirenal tissues. There are multiple treatment strategies for EPN depending on the initial classification; over the last three decades, the treatment approach has favored kidney sparing strategies and the use of nephrectomy only as salvage therapy. We report a case involving a patient with unilateral emphysematous pyelonephritis complicated with hyperglycemic hyperosmolar state (HHS), sepsis, and multiple risk factors associated with poor prognosis who was successfully treated with conservative management sparing nephrectomy. This case report aims to create awareness among clinicians that even in the presence of multiple risk factors for poor prognosis, conservative management should be considered before nephrectomy.

Empagliflozin-induced euglycemic diabetic ketoacidosis is a life-threatening metabolic complication of diabetes mellitus characterized by metabolic acidosis, ketonemia, and relatively normal serum glucose levels. We present a rare case of empagliflozin-induced diabetic ketoacidosis obscured by alkalosis. This case report aims to create awareness among clinicians about this entity and consider this diagnosis in their differential, especially in patients taking sodium-glucose co-transporter (SGLT-2) inhibitors who present to the hospital with unspecific symptoms that may not suggest DKA.