Among young, otherwise healthy adults with unprovoked deep vein thrombosis (DVT), uncommon causes like variation in the normal sequential development of the inferior vena cava (IVC), must be explored. Anomalous IVC conditions are estimated to occur in up to 9% of the general population, with the rarest anomaly being IVC agenesis at 0.0005% - 1% general population prevalence. DVTs are more likely to develop in this population due to venous stasis from decreased venous return, even with the formation of extensive collateral veins. Herein, the authorial team presents a 22-year-old patient with leg pain and swelling who was found to have acute DVT, and, incidentally, the absence of the suprarenal IVC with a robust collateral system on further imaging studies. The morbidity of DVTs in this population is very high, and attention should be given to young patients who present with new-onset DVT in the setting of normal coagulation studies and lack of personal or family history of clotting disorders, as the need for specialized imaging such as venograms is necessary to secure the proper diagnosis.

The clinical and diagnostic workup of fever of unknown origin (FUO) is key in the treatment of patients on the internal medicine service. In this article, the authors present a case of fever of unknown origin, walk through the differential diagnosis, explain the laboratory testing ordered in the workup of the patient as well as the resulting values of said testing, and discuss the pathophysiology and diagnostic criteria for the diagnosis of Pel-Ebstein fever. The authors also discuss a clinical pearl when working with electronic health records to ensure that the needs of the patient in question are met.

The authors present a unique case of schizoaffective disorder exacerbation, complicated by substance misuse, rhabdomyolysis, and acute renal injury. The patient had been recently released from jail and was not on any psychiatric medications aside. His family reported bizarre behavior involving the patient spending a significant amount of time in an outdoor hot tub exposed to extreme heat, which the patient justified as necessary to protect him from snakes. The patient was diagnosed with severe dehydration and rhabdomyolysis, both of which were managed by the primary care team in a hospital setting with specialist input from the psychiatry and renal departments. The patient exhibited paranoid ideations toward the medical team and at times was agitated and combative. Resolution of this distrust was pivotal to successful treatment and was made possible through trilateral communication between the patient, the police officers, and medical staff.

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