A 55-year-old male with a medical history notable for diabetes mellitus and lung cancer was brought to the emergency department via emergency medical services for lethargy and confusion that started a few hours earlier. His family reported that his medications included tramadol 50 mg three times a day as needed for pain and glyburide 5 mg twice a day. A review of systems was taken from his family members, which was positive for nausea, abdominal pain, polyuria, polydipsia, and a recent renal stone. The vital signs included temperature of 37.1 C, blood pressure of 110/60 mm Hg, heart rate of 120 beats/min, respiratory rate of 22 breaths/min, and oxygen saturation rate of 97% on room air. A fingerstick glucose level was 185 mg/dL and an electrocardiogram was initially reported as unremarkable, although a short QT interval was noted. On physical examination, the patient was not oriented to person, place, or time, and appeared dehydrated with dry mucous membranes. Pupils were equal, round, and reactive to light. Other physical examination findings were unremarkable. A basic metabolic panel eventually resulted with a calcium level of 15 mg/dL.

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Introduction: Rhabdomyolysis is a muscle breakdown caused by a variety of factors. Based on a review of the literature, we are unaware of any case reports that discuss these complications of rhabdomyolysis with acalculous cholecystitis and ascites. Case Report: This patient is a 24-year-old man who had never had a chronic illness before. He was a nonsmoker and did not consume alcoholic beverages. He went to the emergency room (ER) because he was having upper abdominal pain and aches throughout his body. He was just started a rigorous physical activity-based training regimen. A total creatine kinase (CK) level more than 5 times higher than the upper normal value confirmed the diagnosis. For the upper abdominal pain, an ultrasound was performed. It reveals ascites and a thick-walled gallbladder. With a decrease in repeated total CK and clinical improvements, the patient was discharged home after aggressive hydration. The patient was asymptomatic at the follow-up appointment, and the ultrasound showed no ascites or gallbladder wall thickness. Conclusion: These are a rare complication of rhabdomyolysis. It implies that acalculous cholecystitis and ascites should be interpreted in light of the clinical scenario and presentation. The workup for ascites and acalculous differential diagnosis was uneventful. In a young patient with rhabdomyolysis, acalculous cholecystitis and ascites is an unusual occurrence.

Introduction: Pneumothorax is a potentially dangerous condition that, if not properly recognized and treated, can have fatal consequences. Chest discomfort or difficulty breathing is common presenting symptoms. We present an atypical presentation for pneumothorax. Case Report: A 26-year-old male patient presented to the emergency department (ED) with complaints of pain in the right iliac fossa with localized rebound tenderness. The treating physician ordered a computed tomography (CT) abdomen to assess for acute appendicitis. From the abdominal CT scan, the radiologist reported a significant right-sided pneumothorax. The patient was treated with a chest thoracostomy and had an unremarkable recovery. Conclusion: All alternative diagnoses are considered in light of the patient’s complaint and clinical presentation. This case reminds physicians of possible atypical clinical presentations of common and serious diseases.

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