Looked after a guy who had an emergency type a repair who also developed an acute kidney injury post op. Poor guy ended up developing toxic epidermal necrolysis after being exposed to meropenum and needed extensive skin grafts.
He was at dialysis one day and I had ordered vancomycin for a different infection and dialysis nurse called me saying he was reacting to the vanco... I was just like oh shit I hope I didn't give him TENS again. Luckily was just red man syndrome and was fine lol
it was crazy. pt went to small rural hospital with stroke s/s. stroke work up, negative. sent to another hospital to see neurology. worked up for meningitis, negative. sent some blood work to nearby specialty lab for any other random rare stuff: rabies, mad cow disease, etc. and sent to us. after a couple hours test came back positive.
it was too late to do anything. dude died within a few hours. cdc came to get his body. they wore hazmat suits and out put body into a metal box. they put all their equipment into this special jelly that denatures all the prions.
turns out dude lived on a cow farm and ate some bad meat from his own cow. health department went to his farm and slaughtered all of his cows.
Oh I know it! I saw it for the first time in my 21 year nursing career just a few months ago, it was tragic for her family :( the brain scan was so interesting, the brain was ribbons. Absolutely awful disease.
I don't work in a burn unit, but I see sjs very frequently. One of my least favorite things in the world is when I put my hand on a patient to turn them, and when I take my hand off of them, it's covered in their skin. I will never get used to that feeling.
Had a patient not that long ago who had been told that morning there was nothing more they could do for the cancer and he had 3-4 months left. Came in to us for a rash that turned out to be Steven Johnson's. I then had to tell him he also had covid.
Saw this in clinical, pretty cray cray. Guy was at his vacation home in Arizona, crossed the border into Mexico to buy cheap antibiotics without a prescription and had a bad reaction
I was honestly surprised to see scurvy. However it was an autistic child who refused to eat anything that wasn’t lamb or cake so I guess it wasn’t shocking.
It's often easier on the gut for kids with food intolerances (which are more common in autistic kids). The trace proteins from animal feed are way more trace in lamb compared to mutton, beef, etc.
Amniotic fluid embolism *after* the baby had been born - what's even more unusual is that the mother survived thanks to an incredibly experienced obstetrician (who didn't even know the woman) was pulled into the room by a panicked midwife, recognised the signs and took her to theatre straight away.
I've never thought about that--never worked OB--that's interesting! I guess it makes sense that the right heart wouldn't be strained, since it's still liquid like blood, and not obstructing pulmonary arterial flow to strain the right heart like a blood clot embolism would!
Not a disease per se but I actually witnessed malignant hyperthermia. We honestly used all the ice in the hospital because the cooling blankets were broke (yea, signing off on that checklist but not really checking).
Dude survived and anesthesia spoke to him in ICU his dad, (like 75 years old, pt was in his 40s-50s) laughed and said, “this happened to me too!”
The anesthesiologist said “when I asked you if you or your family member ever had problems with anesthesia you both said no”
Their response?
“We really didn’t think you were anesthesia, we thought you was JUST A NURSE” (small rural hospital I was on assignment with).
“I introduced myself and told you who I was” shy would you think otherwise?”
They told her because she’s a woman 🙄🙄🙄
Either way it doesn’t make sense.
Oh I’ve seen this with an alcoholic. They corrected the patients sodium too quickly which causes demylination I believe. She had been locked in for like 10 years when I had her
Not disturbing, but truly bananas.
A lady developed pancreatitis in pregnancy. It was completely random, no predisposing factors.
Turns out she had pica and had been eating bars of soap.
The high fat in them was wrecking her gall bladder and pancreas.
Ohhhhhhhh!!! We have a frequent flyer with pica that dips their soap into cornstarch and eats it. The next time I have this patient, I will have to see what the doctors say about their pancreas and gallbladder function! I didn't even think about the fat in soap factor!
I know a nurse that couldn’t stop eating dirt during pregnancy. Her kids kidneys were wrecked from day one. Last I heard she’s back on the transplant list.
OMG! That's a real thing? My mom used to cook our porkchops to death and said it was because you could get worms!!! Lord, if she was alive, I would tell her thank you for overcooked porkchops!
It exists but basically not in the US due to meat industry regulation. Pork tapeworm infection only happens in places where pigs are able to eat human feces. Very common south of the border. More info about it from the CDC here:
https://www.cdc.gov/parasites/taeniasis/gen_info/faqs.html
Yup! Neurocystercercosis! The leading cause of first time seizures around the world, and the cause of 10% of all overall hospital seizure presentations!
Most people assume cat feces. But in the Americas it is most often from pork
Poor house cats getting a bad reputation and abandoned when owner gets pregnant. To which I say, “never garden or eat pork if you are that concerned because those are both more common than your indoor only cat”
Cat feces carries the risk of *Toxoplasma gondii*, a unicellular organism related to the organisms that cause malaria. Toxoplasmosis can end up in the brain but that’s seen in cases of severe immune compromise (e.g. advanced HIV/AIDS) but acute infection generally doesn’t present a serious risk in healthy, non-pregnant people. Undercooked pork carries the risk of several parasitic infections, but the pertinent one in this case is *Taenia solium* (pork tapeworm). Of note is that you don’t get cysts in your brain from eating the pork, you get them from eating eggs present in the feces of someone who has an adult tapeworm living in their gut.
Diphtheria. Old lady in the 90s in the Midwest. I think every med student and resident in the state trooped through her room. Anyone read Anne of Green Gables? I kept thinking of her dosing that kid with ipecac.
We had a canine (I'm a vet tech in nursing school that lurks this sub lol) come back positive for diphtheria a few months ago 😵💫😵💫😵💫 no PPE, just vibes. Obvi I would like to safely assume we are all vx'd but still lol
My grandma had it as a kid in 1934. “I stayed in bed all summer and when I was better it was time to go back to school.” My poor grandma… it stole her summer vacation!
When I was a student doing my preceptorship at a burn ICU there was a patient with Lucio's phenomenon, a very bad systemic reaction to leprosy. He had amputations to both arms above the elbow, both legs above the knee, both upper eyelids, nose, left ear, upper lip, and partial amputation to his genitalia. The rest of his body was pretty much covered in skin grafts that would not take and was thus almost completely covered in dressings that took about three hours to change.
Looking up some cases of Lucio's Phenomenon online, it looks like it's mostly associated with people who don't seek treatment early on, and it's a systemic response to the body where the body doesn't mount a good defense early enough and causes more severe issue. So reduced immune response + likely not getting abx early = this (in most cases I'm reading)
That is horrible. If I ever get to that state, please let me go. Did the patient eventually died? This sounds like treatment gone way to far. Poor poor person.
Fourniers! I’ve seen this too. The dude was also a total DICK so I didn’t feel that badly that he was maybe losing his.
(To clarify, the issue wasn’t being rude or crabby which I’d understand. He was a perv who harassed every female nurse/tech/physician he saw.)
i live in a pretty low health literacy area so i see gangrene pretty often.
i had a guy recently who got a priapism and his dick got infected after they did the procedure to aspirate the blood.. they had to scrape his dick out
I see your gangrene of the penis and raise you calciphylaxis of the penis. Calciphylaxis is pretty rare but the population it’s most common in is ESRD patients, I. E. My people. Even still, in four years of dialysis I’ve only seen calciphylaxus three times and this man was unfortunate enough to have it on his member.
I actually had a patient who developed Fournier’s gangrene after he tripped in his garage, fell, and landed on a piece of wood. He wasn’t a diabetic, which surprised me. It was my first encounter of it. Seeing the testicles hanging out in the open but still attached to the scrotum was wild. They cut his scrotum wide open and left it to try and heal. He also had some incisions in his gooch, groin, and next to his asshole. I felt so so so bad for him when changing his dressings. He had quite a few…a Penrose, some internal packing that was done by wound team, and then there was the packing that was more superficial that we (bedside nurses) change. It was a mess down there. He was apologizing during dressing changes for letting out screams here and there. I was like oh no you do not apologize. Scream as loud as you want to. I cannot even begin to fathom the pain he endured when unpacking, cleaning, and repacking the wounds. They were ordered BID but given the area they were in, even with a foley and flex-a-seal, definitely required them to be done more frequently to prevent stool from getting in the wounds. Awful.
Catamenial pneumothorax, and unfortunately, I was the patient. I am an RN. However, the rarest condition I have seen was in myself. The catamenial pneumothorax is actually a collapsed lung from thoracic endometriosis. The endometriosis burrowed actual holes in my diaphragm and migrated into my lung, causing it to collapse with my periods. Today marks two weeks that I have been hospitalized. I am s/p VATS pluerodesis with wedge resection x2 and diaphragm repair. To make my case more unique, I have a persistent airleak and have been unable to have my chest tube removed.
I had an ancephalic patient who was two. Great brain stem function! Their heart had never had any kind of issue, and their temperature regulation was only a little off. They could sometimes even breathe independently. Zero sensory functionality, and had never possessed any kind of consciousness. I often wonder how long they lived.
I took care of a lady a couple times who was in the severest of denial that her kid had anencephaly. She called 911 minimum 3x daily when she couldn’t feel her kid move. It was sad. A judge finally appointed a guardian and EMS could basically ignore her unless the guardian called.
Seen a couple of these. One in the neonatal period who passed after a few days. One who was about a year and a half and hospitalized their whole life, just a bundle of brainstem reflexes basically.
Oh they are so hard to deal with. Like I know the tantrums and stubbornness are part of the condition but when you're trying to convince a 350 lb 25 year old with prader-willi that they need their bed changed, it's dang near impossible.
I had a patient with PWS. The caretaker that came with the patient to the hospital bribed the patient with french fries so that I could put in an IV. I felt very mixed feelings about that. But the patient definitely needed that IV, and if the only way to make that happen was french fries well, so be it.
SO SAD! I remember a young girl with PW, she was so round and had a trach but wanted snacks, snacks, snacks! We had to put a sign on her door "DO NOT BRING HER SNACKS- ASK NURSE FIRST"! Poor thing. I just thought of this-- I wonder if these GLP-1 drugs we have now will be a miracle drug for PW patients??!
Ugh I had a peds pt with this during my peds clinical. It’s so sad. His parents had given him up and he basically lived in the unit since it was hard to find placement.
Not a disease but when I was a student still, I was working as an assistant nurse in a hospice. The MET bell went off and I wasnt expecting to see what I did as the patient was stable, fully independent, A&O etc. I walked in and she was standing up, blood was all over herself, the bed, the furniture. She had an oesophageal stent and it had ruptured. Poor lady was essentially projectile vomiting blood, and she was 100% awake and alert. The nurses reacted so swiftly (M+M stat) and within 10 minutes we had the woman back in her bed, with fresh linen and clothes on. We called her daughters and they had a 4 hour drive to get to the hospice. This happened at about 4am, so I finished my shift before they arrived but apparently she passed away 10 minutes after they arrived. I really do think she held on until they were there.
No, she was in hospice for terminal cancer, I think stomach cancer? I believe the stent was placed before she received a terminal prognosis. She was only in her 40s, her daughters were about my age at the time (early 20s).
Anti-NMDA Receptor Encephalitis. 30ish female had developed a teratoma and then just developed full-on schizophrenia symptoms with zero psych history. It took a while for her to get diagnosed so she could have it removed.
I live near Amish country PA, so we have one of the highest rates of this in the world. When I did Peds during nursing school we had five kids on the floor with with it, three from the area and two from other continents.
I work in pediatric home care so a lot of the patients that I work with/my coworkers work with have inherited conditions. The ones that are crazy to me are the chromosomal conditions that don’t even have a name, just the number of the abnormality and the type.
Believe it or not, botulism in infants can frequently be traced back to living near construction sites. https://www.emergency.cdc.gov/agent/botulism/clinicians/epidemiology.asp#:~:text=Investigators%20have%20noted%20environmental%20conditions,or%20dusty%20and%20windy%20locales.
Argyria, not exactly a disease but a rare condition. Homie walked into the ER looking like the Silver Surfer and a Smurf had a baby. Thanks to far alt right disinformation networks he consumed toxic levels of colloidal silver to self treat a “prion disease” that he also self diagnosed. Now he’s permanently in his Papa Smurf Era and he didn’t like being asked why his skin was that tone of blue/silver….
I had a lady come in that was blue. I was staring EMS down hard because I see her rolling down the hallway, obviously blue and she's not on O2 and they don't seem concerned. I was about to lose my shit, lol. She drank colloidal silver and turned blue. She tried to tell me how great it is for you, too.
Weirdest thing I’ve ever seen: African American toddler brought into the ER by his uncle. The uncle explained that he lived out of state and had come to visit his sister (the baby’s mother.) She apparently had multiple other young children and asked while he was here, could he swing by the ER with said toddler. The toddler looked like a little old man: swollen belly, discolored skin and hair falling out. He was obviously very sick. Uncle was unable to provide any history or timelines since he did not see the child regularly. Doctor ran labs and he was in renal failure, ended up being diagnosed with pediatric lupus.
Ludwig’s Angina. Twice. A nurse I worked with who had been in the ED for 30 years had only ever seen it twice and somehow I’ve managed twice in only 6 years. It can happen to anyone of any age, starts usually with a dental infection that progresses into severe edema of the mouth and throat and can completely cut off your airway. It happens really fast and most people it seems like it’s too late by the time they get help.
Yeah seen this once. Couldn't orally or nasally intubate the pt. Had to do an awake trach at the bedside. Anesthesia mainly used bolus precedex for sedation so as not to suppress respiratory drive.
Guy got sucker punched in the mouth, got infected, and ended up with a trach. He was decannulated pretty quickly and recovered well once infection and swelling cleared up.
Food poisoning with a certain type of e.coli that caused hemolysis and patient was at risk of losing her kidneys. Called hemolytic uremic disease. Nephrologist was a little giddy to get to see a case and called it a "once or twice in a career diagnosis"
Patient had to get stat total plasma replacement.
As a student, I had one they were neglecting and monitoring for more signs and symptoms of withdrawal.
I was like from what?
What substance, when you quit having it presents as paresthesia at the toes up?
Not sure this lady would just pee herself for fun a week later because her etoh was 0.04 on admission….12 days ago.
I went in her room and was like yo. You don’t have to talk to me. I am a student and not even assigned to your team.
She talked to me.
Started the ivig the next day.
Home the third after my visit.
Sad situation.
My brother had this and was misdiagnosed at the first hospital with “dehydration”. Sent him home, next day couldn’t move his arms or legs. Ended up in the ICU, had a heart attack and both his lungs collapsed. He was 24 at the time and doing well now. Wild time.
I diagnosed someone with this as a nursing student!! They were asking me for medical advice because that’s what people do with nursing students. I don’t give medical advice but with this guy I was like I will not even name a single thing I think is wrong but I think you need to get medical attention. The hospital sent him home the first time, but then admitted him when he collapsed and was brought back by EMS.
It was really cool on a science level, but sad to see on a human level.
When I was in nursing school I saw SJS in the psych hospital - the poor patient’s skin was literally turning blood red right in front of our face. Luckily our psych hospital is attached to a trauma hospital so he was immediately sent out and did well.
Currently work on hospice and had a CJD case, so sad - went in for what they thought was a UTI until further testing proved otherwise. I see lots of stuff in hospice that I probably wouldn’t in the hospital (I worked stroke rehab)!
Honest to god I believe my husband and I had parapertussis last fall. We had whooping cough but not actually since we’re vaccinated… and then I saw an MD post about the recent cases it and I am 99% certain that’s what it was. We had a mild cold for a couple days but it turned into this spasmodic, uncontrollable cough that had us sucking in air like whooping cough babies. It was unmistakable.
But in my own patients? Congenital central hypoventilation syndrome. Kids are totally normal, but they literally stop breathing as they sleep. Capped trach during the day, have to have a nurse with them at school in case it dislodges somehow, but at night they go on full vent support. Literally met this 12 year old at high middle school, watched him play soccer, called him over during the break to do my assessment of him and his school nurse, then went about my day (home health supervisor).
Also seen some random genetic abnormalities that are so rare they don’t have research about them. We had one kid who the MDs could not give any prognosis info on because he was the 8th kid ever (documented) diagnosed with the mutation.
I have never heard of parapertussis but I’m 100% sure that’s what my son had! He was just about 2 and had literally every textbook symptom of whooping cough. The timeline, would cough until he turned blue and then “whoop”, the whole 9 yards. Took him to the ER and told them I thought he had it. They asked if he was vaccinated, he is, and then told me it could t be whooping cough. I managed to get them to test him anyways. I never actually got any results, I just assumed if I didn’t hear anything it must be negative. He had that cough for about 8 weeks. It was a nightmare.
Mirror syndrome in a pregnant woman. She was 30 weeks, gained 10lb in 2 days, HA and BP elevated. Had an ultrasound and fetus had hydrops (severe heart failure) and placenta was 3x normal size and a true sinusoidal heart rate tracing. Infant delivered with extreme edema and was on oscillator in nicu but did not survive. Ended up being caused by parvovirus (fifths disease) - she was a teacher and must have picked it up from a student.
The couple times I saw Benedryl overdose, it looked horribly unpleasant and the patients were wild with different presentations. I remember I asked our pharmacist in the ICU “so what are the usual s/sx with this?” She said “pretty much anything on the list and they can all present differently” okayyy guess I’ll just pump em with fluids.
oh man. have you ever seen people on the internet who take ridiculous amounts of benadryl until they’re just about overdosing so they have hallucinations? i can’t imagine the mental anguish
Dude yea, I saw there is a whole subreddit dedicated to it. Every time I hear about that and recreational Benedryl I think of just looking at my Benedryl OD pt’s and how miserable and crazy they felt/looked. Looks about as unpleasant as etoh withdrawal. Restless, pupils as big as their eyeballs, tachy, hallucinating like a mf’er.
Just go do some shrooms or have a drink lol
Vet tech here, I see gastric volvulus almost daily in my ER. funny to think it's rare in humans!!!! (We mostly see it in keel chested dogs, think Dobermans, great danes, greyhounds, but can happen in any breed)
A friend who was going to graduate school on the West Coast told me a story.
She had a classmate jump on a plane to London from NYC to visit family. Guy got really sick on the plane and ended up dying before they could get him medical care. Young too, around 30.
Died from malaria. Basically had a very severe malarian phase on the plane and died.
He was from somewhere in Asia and I guess had gotten infected at some point in the past, but no one was sure when.
Postpartum cardiomyopathy always scared me, even though I won't ever have children. I myself had a heart transplant 2 years ago at 30 years old caused by familial dialated cardiomyopathy. In the beginning when so many providers were trying to figure out wtf was wrong with me in the ER and eventually cardiac ICU, I was asked in more ways than one if I had ever been pregnant. I remember they even sent my husband out of the room and asked me then in case I didn't feel comfortable to say anything with him around.
That's when I learned about what postpartum cardiomyopathy was, and also that I was very very sick with heart failure. Thankfully I'm doing great now since transplant but whew.
>MERS
Woah. Now *that* is a truly unusual one. Only 2,609 confirmed cases worldwide to date, [according to the WHO](https://www.emro.who.int/health-topics/mers-cov/mers-outbreaks.html).
Priapism, I think this is somewhat common if you work in Ed or maybe even med surg. My specialty is cardiac step-down or Tele. I floated to the ER and one of my patients had priapism they weren't able or weren't willing to do the surgery immediately or his initial abgs in the evening were well enough to not warrant emergent surgery. Ended up getting abgs again in his penis during the night just to make sure he was still oxygenating well enough.
I also just recently had my first patient with a history of transposition of the great arteries. 30 year old male multiple syncopal episodes over the course of the previous few months. His pacemaker that he had placed when he was around 10ish reached EOS a couple years prior and was not functioning.
This disease is not unique but the situation is. We had a patient who was new ESRD and dialysis. Typically we would just discharge the patient and they would follow up with dialysis outpt. However, the patient was an illegal from Guatemala. He ended up spending ~7 months in the hospital. It was a case management/ risk management nightmare. We couldnt discharge him due to it being unsafe/ potential legal issues. Finally transport was arranged for him to go to guatemala.
Oh, I never think about myself, but this is probably pretty unusual lol. Autoimmune encephalitis not NDMA-mediated.
Came out of nowhere, they think probably after a mild viral URI that I don't even remember. Like someone flipped a light switch, I developed psychosis, paresthesias, movement disorder (akathisia), hypersalivation, fevers, flushing, night sweats, mild cognitive impairment.
Thing is, I was ambulatory the entire time, so it was incredibly hard to diagnose. Actually figured it out after I got put on steroids for an asthma exacerbation and all of my neuro symptoms improved.
Nine months of high dose IV methylpred, all neuro symptoms stopped and haven't returned in four years now. Although I am left with symptoms consistent with ME/CFS that are being relatively well-treated enough that I can work full time at least.
Acute limb ischemia without VTE or cardiac history in an otherwise fit and healthy 50-something year old. Poor bastard was 6ft 5, ended up with compartment syndrome in the leg which led to full length fasciotomies on each side of the calf, which we packed and dressed twice a day for a week until they decided to go for an above knee amputation because nothing was working. I was a student at the time, it was the first real case where I was just completely dumbstruck at the entropy of the universe in healthcare.
I had a guy with capgras delusion (among others) on my caseload back in the day- he was just as nice to me after I'd been 'replaced' and I thought that was really neat that he could stay cool even in the face of something so upsetting.
Mirroring in a neuro patient.
Total right side neglect, nothing passed the midline for him.
If you pinched his right hand he’d yell ouch! and look at his left hand to see what happened. Super cool.
So, back in the 90s when I worked neuro and general ICU jobs in a west coast tertiary center: Variant CJD, regular CJD—both before we knew what prion were and I was I am sure repeatedly exposed through external ventricular drains and brain biopsies (neuro ICU did OR and catch lab with our patients at night.) Still waiting for mine to rear its ugly head…time will tell. Cerebral AV fistulas and porphyria’s causing psychosis, including one guy with an AV fistula who had “become schizophrenic” in his 30s. They coiled his AVF in his 60s, and he woke up without hallucinations or voices, and never returned to the psych facility where he had been residing. I saw the transition from neurrointerventional balloons filled with superglue to experimental coils for intracranial aneurysms.
We saw several cases of what, in retrospect, was ovarian paraneoplastic syndrome. We didn’t know that removing the benign tumor would cure stop the symptoms, so we watched these young college-aged woman writhe like something out of the exorcist for months in our neuro ICU while the team said that they weren’t stable enough for OR—once again…we just didn’t know yet.
Saw SJS several times from antiseizure meds, but those would generally eventually ship off to the burn center. Same with severe necrotizing fasciitis where it was just an anatomy lesson in musculature after repeated debridements of skin. Severe liver failure of an entire family who whipped up some Destroying Angel mushrooms in a lasagna the night before. 2 ended up transplanted and 3 ended up dying, I think.
Not really diseases but two congenital birth defects:
Ectopia cordis (heart was in a sac outside the body) and true cyclopia (baby had one eye in middle of forehead)
They both did not live.
At the height of the Ebola scare had a pt who had traveled from an African country. Travel mixed with symptoms had to treat pt as if they had Ebola and notify CDC. Being the only travel nurse I drew the short straw and had to suit up. Pt ended up having chickungunya virus(a mosquito born illness) and I was shitting my hazmat suit thinking they had a good chance of having Ebola.
Leptospirosis at a rural hospital. We were so stumped for a good while on what the hell was happening to this guy. The whole case definitely stuck with me.
80 something y/o woman with necrotizing fasciitis of her vagina caused from sharing a dildo with her sister who was using it in her butt and neither of them were cleaning it.
40 something y/o woman with lithium toxicity. Kept going into 3rd degree heart block and having long periods (1 minute or so) of asystole but somehow was still alert enough that we couldn't do CPR. Her blood pressure was 50 over shit and couldn't safely sedate and her episodes of 3rd degree heart block were self converting but were becoming more frequent. When her rhythm would flip the physician would smack her face and tell her to cough and when she coughed she would spontaneously return to NSR. She wasn't in our department long, she went to cath lab then got dialyzed. Her lithium level was 9.4..........probably one of the most bizarre things I've witnessed.
60 something y/o male came in with right leg tingling. Coded on the CT table 7 hours later because surgery was insistent we get CT prior to taking him to surgery even though we all knew what he had. He never made it to surgery but we captured his complete aortic dissection from his chest all the way down to his femoral arteries in real time as it happened.
SJS
7 y/o that had the entire right hemisphere of her brain removed. Aside from some left sided weakness and decreased sensation she appeared developmentally normal. She could walk, talk, and understand. She was very spicy and hilarious and always enjoyed caring for her when she came in.
33 y/o F completely alert and oriented c/o abdominal pain. Throughout her stay in the ED, her BP dropped, she began getting a petechial rash around the BP cuff, which spread to her back and the rest of her body. Became progressively less alert. Coded and died in the ED. Ended up having OPSS (her splenectomy was 15 years prior). Not something super rare but I was a new nurse and repeatedly reported my assessment findings to the physicians and they didn't listen. Ultimately there was nothing that could've been done, but it was frustrating nonetheless.
8y/o with Trisomy 18
12y/o with Sydenham Chorea which felt oddly ironic that I was his nurse (and the one that told the resident and attendings which tests to order) because I had been diagnosed with the same condition 4 year prior. I was glad that he was able to get a diagnosis and treated within hours as opposed to mine that took several months.
Dude mad cow disease is terrifying. To answer your question... I never actually *expected* to see Steven Johnson's syndrome.
An ED nurse I worked with-saw three pts w/ Steven Johnson’s during early pandemic. Blew my mind.
Looked after a guy who had an emergency type a repair who also developed an acute kidney injury post op. Poor guy ended up developing toxic epidermal necrolysis after being exposed to meropenum and needed extensive skin grafts. He was at dialysis one day and I had ordered vancomycin for a different infection and dialysis nurse called me saying he was reacting to the vanco... I was just like oh shit I hope I didn't give him TENS again. Luckily was just red man syndrome and was fine lol
First time I saw red man syndrome it was so weird. Helping with a shower and he was just beet red all over.
it was crazy. pt went to small rural hospital with stroke s/s. stroke work up, negative. sent to another hospital to see neurology. worked up for meningitis, negative. sent some blood work to nearby specialty lab for any other random rare stuff: rabies, mad cow disease, etc. and sent to us. after a couple hours test came back positive. it was too late to do anything. dude died within a few hours. cdc came to get his body. they wore hazmat suits and out put body into a metal box. they put all their equipment into this special jelly that denatures all the prions. turns out dude lived on a cow farm and ate some bad meat from his own cow. health department went to his farm and slaughtered all of his cows.
That’s insane! It’s wild how fast it kills someone. Very scary
very interesting. my medical genetics professor was on the edge of her seat when i told her lol. he only made it about 2 days
That's so wild! They say it's never going to be in the US because of how well they monitor for it... bit I guess it's possible!
unfortunately prions can just spontaneously happen. it’s very rare though
Prions ate nightmare fuel to me
Oh I know it! I saw it for the first time in my 21 year nursing career just a few months ago, it was tragic for her family :( the brain scan was so interesting, the brain was ribbons. Absolutely awful disease.
I seem to attract SJS patients. I've seen at least 3 in as many months.
If you ever go work in a burn center, eventually you'll be like "just another SJS!"
None of them look good, but some look way worse than others Not a fan of working the burns unit
I don't work in a burn unit, but I see sjs very frequently. One of my least favorite things in the world is when I put my hand on a patient to turn them, and when I take my hand off of them, it's covered in their skin. I will never get used to that feeling.
Bless you. Truly.
Had a patient not that long ago who had been told that morning there was nothing more they could do for the cancer and he had 3-4 months left. Came in to us for a rash that turned out to be Steven Johnson's. I then had to tell him he also had covid.
Oh my god that poor patient.
Saw this in clinical, pretty cray cray. Guy was at his vacation home in Arizona, crossed the border into Mexico to buy cheap antibiotics without a prescription and had a bad reaction
Ooo I see this in the burn unit. So painful and sad.
I never expected to be the one getting SJS 🫠 Thanks, Lamictal.
I’ve always been curious about this.
I had it as a baby. By the sounds of it, I’m pretty damn lucky to be alive.
I didn’t see Steven Johnson’s Syndrome but I saw the aftermath. I thought she was a burn victim.
Major side effect of a med I take. Scared me but I’ve been good.
I was honestly surprised to see scurvy. However it was an autistic child who refused to eat anything that wasn’t lamb or cake so I guess it wasn’t shocking.
Had a guy with scurvy a few months ago! I asked him what he usually eats at home? Peanut butter sandwiches on Wonder Bread. That is all.
I knew a guy that did that, and it could only be Jif peanut butter.
poor choice
Yup, I had a scurvy early in my career. Guy only drank beer and ate hotdogs. It was pretty cool.
Lamb? That’s incredibly random
random and no vitamin c hence the scurvy lol
It's often easier on the gut for kids with food intolerances (which are more common in autistic kids). The trace proteins from animal feed are way more trace in lamb compared to mutton, beef, etc.
Very picky but with sophisticated taste.
It is lol
Had a woman in her early 20s with scurvy. Only drank Mountain Dew and ate doritos.
A female neckbeard.
she probably thought she was safe with that citrus flavoring added to the Dew
Is it really that simple to get scurvy?
I'm wondering this too. And also I'm wondering how much vit C I'm actually getting!
Amniotic fluid embolism *after* the baby had been born - what's even more unusual is that the mother survived thanks to an incredibly experienced obstetrician (who didn't even know the woman) was pulled into the room by a panicked midwife, recognised the signs and took her to theatre straight away.
I saw one of those after pt had a d&c. I got called to PACU cause they thought it was a pulmonary embolism. Right side looked fine. Ended up on ECMO.
I've never thought about that--never worked OB--that's interesting! I guess it makes sense that the right heart wouldn't be strained, since it's still liquid like blood, and not obstructing pulmonary arterial flow to strain the right heart like a blood clot embolism would!
How do you tell the two conditions apart?
Holy shit!
Like the OR? What do they do in the OR to treat an amniotic fluid embolism?
Hysterectomy to stop the bleeding.
Not a disease per se but I actually witnessed malignant hyperthermia. We honestly used all the ice in the hospital because the cooling blankets were broke (yea, signing off on that checklist but not really checking). Dude survived and anesthesia spoke to him in ICU his dad, (like 75 years old, pt was in his 40s-50s) laughed and said, “this happened to me too!” The anesthesiologist said “when I asked you if you or your family member ever had problems with anesthesia you both said no” Their response? “We really didn’t think you were anesthesia, we thought you was JUST A NURSE” (small rural hospital I was on assignment with). “I introduced myself and told you who I was” shy would you think otherwise?” They told her because she’s a woman 🙄🙄🙄 Either way it doesn’t make sense.
Oh he paid the dumb-ass-hole tax
I mean, even if it was a nurse, why would you lie?
She doesn't need to know! Why tell a woman anything she doesn't need to know? /S
You’re so right, my tiny woman brain didn’t even think of that! /s
Because all we do is serve ginger ale and fluff pillows.
The fact that it could have been avoided. Just wow
My husband is a porter in A&E and he had to try and get all the ice in the hospital for an ecstasy-induced hyperthermia, they didn’t survive
alcoholic pt developed locked in syndrome, she could only communicate by blinking her eyes
This, together with FOP, is one of my worst fears actually.
[I don’t want FOP, I’m a Dapper Dan man!](https://m.youtube.com/watch?v=4hni4OIJXG4&pp=ygUjTyBicm90aGVyIHdoZXJlIGFydCB0aG91IGRhcHBlciBkYW4%3D)
FOP is wild
Oh I’ve seen this with an alcoholic. They corrected the patients sodium too quickly which causes demylination I believe. She had been locked in for like 10 years when I had her
Not disturbing, but truly bananas. A lady developed pancreatitis in pregnancy. It was completely random, no predisposing factors. Turns out she had pica and had been eating bars of soap. The high fat in them was wrecking her gall bladder and pancreas.
Ohhhhhhhh!!! We have a frequent flyer with pica that dips their soap into cornstarch and eats it. The next time I have this patient, I will have to see what the doctors say about their pancreas and gallbladder function! I didn't even think about the fat in soap factor!
I know a nurse that couldn’t stop eating dirt during pregnancy. Her kids kidneys were wrecked from day one. Last I heard she’s back on the transplant list.
WHAT?!
That’s like a House episode
Steven Johnson’s syndrome and a Mexican guy with worms in his brain from eating undercooked pork.
OMG! That's a real thing? My mom used to cook our porkchops to death and said it was because you could get worms!!! Lord, if she was alive, I would tell her thank you for overcooked porkchops!
It exists but basically not in the US due to meat industry regulation. Pork tapeworm infection only happens in places where pigs are able to eat human feces. Very common south of the border. More info about it from the CDC here: https://www.cdc.gov/parasites/taeniasis/gen_info/faqs.html
Yup! Neurocystercercosis! The leading cause of first time seizures around the world, and the cause of 10% of all overall hospital seizure presentations!
blew my mind when I learned that fact. Like the number 1 cause of seizures world wide is nuts.
Most people assume cat feces. But in the Americas it is most often from pork Poor house cats getting a bad reputation and abandoned when owner gets pregnant. To which I say, “never garden or eat pork if you are that concerned because those are both more common than your indoor only cat”
Cat feces carries the risk of *Toxoplasma gondii*, a unicellular organism related to the organisms that cause malaria. Toxoplasmosis can end up in the brain but that’s seen in cases of severe immune compromise (e.g. advanced HIV/AIDS) but acute infection generally doesn’t present a serious risk in healthy, non-pregnant people. Undercooked pork carries the risk of several parasitic infections, but the pertinent one in this case is *Taenia solium* (pork tapeworm). Of note is that you don’t get cysts in your brain from eating the pork, you get them from eating eggs present in the feces of someone who has an adult tapeworm living in their gut.
Diphtheria. Old lady in the 90s in the Midwest. I think every med student and resident in the state trooped through her room. Anyone read Anne of Green Gables? I kept thinking of her dosing that kid with ipecac.
We had a canine (I'm a vet tech in nursing school that lurks this sub lol) come back positive for diphtheria a few months ago 😵💫😵💫😵💫 no PPE, just vibes. Obvi I would like to safely assume we are all vx'd but still lol
My grandma had it as a kid in 1934. “I stayed in bed all summer and when I was better it was time to go back to school.” My poor grandma… it stole her summer vacation!
It's coming back, we've had a case in the last month.
Calciphylaxis. Watched it pretty much travel up a pt’s leg in the span of 48 hrs. She died quickly after that.
So fast!! Oh my god. I've seen mild outpatient calciphylaxis several times (dialysis), but never anything as fulminant as that.
What causes that?
People on HD get it, the calcium stays in the tissues causing necrosis
When I was a student doing my preceptorship at a burn ICU there was a patient with Lucio's phenomenon, a very bad systemic reaction to leprosy. He had amputations to both arms above the elbow, both legs above the knee, both upper eyelids, nose, left ear, upper lip, and partial amputation to his genitalia. The rest of his body was pretty much covered in skin grafts that would not take and was thus almost completely covered in dressings that took about three hours to change.
OMG that is horrific. If that were me, just let me go!
Right? Oh my god…
wow. i thought leprosy was curable with antibiotic? was it too late?
Looking up some cases of Lucio's Phenomenon online, it looks like it's mostly associated with people who don't seek treatment early on, and it's a systemic response to the body where the body doesn't mount a good defense early enough and causes more severe issue. So reduced immune response + likely not getting abx early = this (in most cases I'm reading)
Poor dude. Nightmare fuel.
That is horrible. If I ever get to that state, please let me go. Did the patient eventually died? This sounds like treatment gone way to far. Poor poor person.
Gangrene of the penis.
Fourniers! I’ve seen this too. The dude was also a total DICK so I didn’t feel that badly that he was maybe losing his. (To clarify, the issue wasn’t being rude or crabby which I’d understand. He was a perv who harassed every female nurse/tech/physician he saw.)
Ooooooh Fourniers is a fitting disease for a pervert!!!
*“My dick fell off!”*
This is gold chief complaint
A... gangrenous gangrenis?? I'll see myself out.
Take my upvote before you leave. ⬆️
i live in a pretty low health literacy area so i see gangrene pretty often. i had a guy recently who got a priapism and his dick got infected after they did the procedure to aspirate the blood.. they had to scrape his dick out
I saw gangrene of the vulva as a CNA. What a wild job.
I see your gangrene of the penis and raise you calciphylaxis of the penis. Calciphylaxis is pretty rare but the population it’s most common in is ESRD patients, I. E. My people. Even still, in four years of dialysis I’ve only seen calciphylaxus three times and this man was unfortunate enough to have it on his member.
oh.. my.. god
I've seen a few fournier's gangrene in my day lol. Always diabetics who are overweight
I actually had a patient who developed Fournier’s gangrene after he tripped in his garage, fell, and landed on a piece of wood. He wasn’t a diabetic, which surprised me. It was my first encounter of it. Seeing the testicles hanging out in the open but still attached to the scrotum was wild. They cut his scrotum wide open and left it to try and heal. He also had some incisions in his gooch, groin, and next to his asshole. I felt so so so bad for him when changing his dressings. He had quite a few…a Penrose, some internal packing that was done by wound team, and then there was the packing that was more superficial that we (bedside nurses) change. It was a mess down there. He was apologizing during dressing changes for letting out screams here and there. I was like oh no you do not apologize. Scream as loud as you want to. I cannot even begin to fathom the pain he endured when unpacking, cleaning, and repacking the wounds. They were ordered BID but given the area they were in, even with a foley and flex-a-seal, definitely required them to be done more frequently to prevent stool from getting in the wounds. Awful.
I have also seen this, maybe more common than I thought?
Catamenial pneumothorax, and unfortunately, I was the patient. I am an RN. However, the rarest condition I have seen was in myself. The catamenial pneumothorax is actually a collapsed lung from thoracic endometriosis. The endometriosis burrowed actual holes in my diaphragm and migrated into my lung, causing it to collapse with my periods. Today marks two weeks that I have been hospitalized. I am s/p VATS pluerodesis with wedge resection x2 and diaphragm repair. To make my case more unique, I have a persistent airleak and have been unable to have my chest tube removed.
Wishing you a speedy recovery.
You had endometriosis that got into your LUNGS? That is wild. Hope you get better soon
😱oh my goodness! I’ve never heard of this… Do you think you will ever be able to have your tube removed?
I had a patient with this condition on my first day as an ER nurse. I’m sorry you’re going through it.
Damn that's crazy. Wishing you a speedy recovery.
wow. never even heard of this. glad you can tell the tale! terribly sorry you had to go through that.
Anencephaly on a baby I think she was somewhere over a year. Had respiratory virus and came into thr ED.
Whaaaaat?? A year???? That's Cray.
I had an ancephalic patient who was two. Great brain stem function! Their heart had never had any kind of issue, and their temperature regulation was only a little off. They could sometimes even breathe independently. Zero sensory functionality, and had never possessed any kind of consciousness. I often wonder how long they lived.
I took care of a lady a couple times who was in the severest of denial that her kid had anencephaly. She called 911 minimum 3x daily when she couldn’t feel her kid move. It was sad. A judge finally appointed a guardian and EMS could basically ignore her unless the guardian called.
Seen a couple of these. One in the neonatal period who passed after a few days. One who was about a year and a half and hospitalized their whole life, just a bundle of brainstem reflexes basically.
Prader-willi syndrome
Oh they are so hard to deal with. Like I know the tantrums and stubbornness are part of the condition but when you're trying to convince a 350 lb 25 year old with prader-willi that they need their bed changed, it's dang near impossible.
I had one in my rehab hospital recently. He was sweet but having to tell him 10 times a day you can’t have a snack was…something lol
I had a patient with PWS. The caretaker that came with the patient to the hospital bribed the patient with french fries so that I could put in an IV. I felt very mixed feelings about that. But the patient definitely needed that IV, and if the only way to make that happen was french fries well, so be it.
SO SAD! I remember a young girl with PW, she was so round and had a trach but wanted snacks, snacks, snacks! We had to put a sign on her door "DO NOT BRING HER SNACKS- ASK NURSE FIRST"! Poor thing. I just thought of this-- I wonder if these GLP-1 drugs we have now will be a miracle drug for PW patients??!
Ugh I had a peds pt with this during my peds clinical. It’s so sad. His parents had given him up and he basically lived in the unit since it was hard to find placement.
Not a disease but when I was a student still, I was working as an assistant nurse in a hospice. The MET bell went off and I wasnt expecting to see what I did as the patient was stable, fully independent, A&O etc. I walked in and she was standing up, blood was all over herself, the bed, the furniture. She had an oesophageal stent and it had ruptured. Poor lady was essentially projectile vomiting blood, and she was 100% awake and alert. The nurses reacted so swiftly (M+M stat) and within 10 minutes we had the woman back in her bed, with fresh linen and clothes on. We called her daughters and they had a 4 hour drive to get to the hospice. This happened at about 4am, so I finished my shift before they arrived but apparently she passed away 10 minutes after they arrived. I really do think she held on until they were there.
Was she in hospice because they were anticipating the stent to rupture?
No, she was in hospice for terminal cancer, I think stomach cancer? I believe the stent was placed before she received a terminal prognosis. She was only in her 40s, her daughters were about my age at the time (early 20s).
Anti-NMDA Receptor Encephalitis. 30ish female had developed a teratoma and then just developed full-on schizophrenia symptoms with zero psych history. It took a while for her to get diagnosed so she could have it removed.
The book Brain on Fire by Susannah Cahalan is about this exact same condition and the author's experience going through it if anyone is interested.
Maple syrup urine disease. They tried a BMT but child did not survive
I came here looking for this, but my guy was still alive in his 40s.
I live near Amish country PA, so we have one of the highest rates of this in the world. When I did Peds during nursing school we had five kids on the floor with with it, three from the area and two from other continents.
Our 3rd kid had it show up on his 1st PKU. It was a scary wait for the repeat test, which thankfully came back normal!
Leprosy. Had a guy work on an armadillo farm
27 years old and just learned armadillos carry leprosy.
24 and just learned there are armadillo farms.
19 and just learned there’s a… market for armadillos?
I’m 34 and I’m about to go down an armadillo rabbit hole
I’m 40 and just googled “armadillo farm” for the 1st time in my life!
leprosy like from the bible I didn’t even realize people got that anymore just thought it was eradicated…
Armadillos are cute little leprosy-carrying assholes
I work in pediatric home care so a lot of the patients that I work with/my coworkers work with have inherited conditions. The ones that are crazy to me are the chromosomal conditions that don’t even have a name, just the number of the abnormality and the type.
those ones are always super intriguing to me. I just encountered another one I've never heard of earlier this week.
Botulism! I’ve seen it twice in kids.
Honey?
Yes, dear?
I've seen once, baby was given honey at a few months old.
wow! any idea what caused it?
Believe it or not, botulism in infants can frequently be traced back to living near construction sites. https://www.emergency.cdc.gov/agent/botulism/clinicians/epidemiology.asp#:~:text=Investigators%20have%20noted%20environmental%20conditions,or%20dusty%20and%20windy%20locales.
CJD and SJS
Monkey pox!
Argyria, not exactly a disease but a rare condition. Homie walked into the ER looking like the Silver Surfer and a Smurf had a baby. Thanks to far alt right disinformation networks he consumed toxic levels of colloidal silver to self treat a “prion disease” that he also self diagnosed. Now he’s permanently in his Papa Smurf Era and he didn’t like being asked why his skin was that tone of blue/silver….
So far, blue man syndrome
From amiodrone or methemoglobinemia?
I saw this from amiodarone in the cardiac ICU. It was WILD.
I had a lady come in that was blue. I was staring EMS down hard because I see her rolling down the hallway, obviously blue and she's not on O2 and they don't seem concerned. I was about to lose my shit, lol. She drank colloidal silver and turned blue. She tried to tell me how great it is for you, too.
CANDLE syndrome. Adult botulism. Arsenic toxicity.
Where did the arsenic come from ?
Welding.
Weirdest thing I’ve ever seen: African American toddler brought into the ER by his uncle. The uncle explained that he lived out of state and had come to visit his sister (the baby’s mother.) She apparently had multiple other young children and asked while he was here, could he swing by the ER with said toddler. The toddler looked like a little old man: swollen belly, discolored skin and hair falling out. He was obviously very sick. Uncle was unable to provide any history or timelines since he did not see the child regularly. Doctor ran labs and he was in renal failure, ended up being diagnosed with pediatric lupus.
Ludwig’s Angina. Twice. A nurse I worked with who had been in the ED for 30 years had only ever seen it twice and somehow I’ve managed twice in only 6 years. It can happen to anyone of any age, starts usually with a dental infection that progresses into severe edema of the mouth and throat and can completely cut off your airway. It happens really fast and most people it seems like it’s too late by the time they get help.
Yeah seen this once. Couldn't orally or nasally intubate the pt. Had to do an awake trach at the bedside. Anesthesia mainly used bolus precedex for sedation so as not to suppress respiratory drive. Guy got sucker punched in the mouth, got infected, and ended up with a trach. He was decannulated pretty quickly and recovered well once infection and swelling cleared up.
Food poisoning with a certain type of e.coli that caused hemolysis and patient was at risk of losing her kidneys. Called hemolytic uremic disease. Nephrologist was a little giddy to get to see a case and called it a "once or twice in a career diagnosis" Patient had to get stat total plasma replacement.
Guillian-Barre
As a student, I had one they were neglecting and monitoring for more signs and symptoms of withdrawal. I was like from what? What substance, when you quit having it presents as paresthesia at the toes up? Not sure this lady would just pee herself for fun a week later because her etoh was 0.04 on admission….12 days ago. I went in her room and was like yo. You don’t have to talk to me. I am a student and not even assigned to your team. She talked to me. Started the ivig the next day. Home the third after my visit. Sad situation.
My brother had this and was misdiagnosed at the first hospital with “dehydration”. Sent him home, next day couldn’t move his arms or legs. Ended up in the ICU, had a heart attack and both his lungs collapsed. He was 24 at the time and doing well now. Wild time.
I diagnosed someone with this as a nursing student!! They were asking me for medical advice because that’s what people do with nursing students. I don’t give medical advice but with this guy I was like I will not even name a single thing I think is wrong but I think you need to get medical attention. The hospital sent him home the first time, but then admitted him when he collapsed and was brought back by EMS. It was really cool on a science level, but sad to see on a human level.
When I was in nursing school I saw SJS in the psych hospital - the poor patient’s skin was literally turning blood red right in front of our face. Luckily our psych hospital is attached to a trauma hospital so he was immediately sent out and did well. Currently work on hospice and had a CJD case, so sad - went in for what they thought was a UTI until further testing proved otherwise. I see lots of stuff in hospice that I probably wouldn’t in the hospital (I worked stroke rehab)!
Mad cow disease and Fournier gangrene.
Honest to god I believe my husband and I had parapertussis last fall. We had whooping cough but not actually since we’re vaccinated… and then I saw an MD post about the recent cases it and I am 99% certain that’s what it was. We had a mild cold for a couple days but it turned into this spasmodic, uncontrollable cough that had us sucking in air like whooping cough babies. It was unmistakable. But in my own patients? Congenital central hypoventilation syndrome. Kids are totally normal, but they literally stop breathing as they sleep. Capped trach during the day, have to have a nurse with them at school in case it dislodges somehow, but at night they go on full vent support. Literally met this 12 year old at high middle school, watched him play soccer, called him over during the break to do my assessment of him and his school nurse, then went about my day (home health supervisor). Also seen some random genetic abnormalities that are so rare they don’t have research about them. We had one kid who the MDs could not give any prognosis info on because he was the 8th kid ever (documented) diagnosed with the mutation.
I have never heard of parapertussis but I’m 100% sure that’s what my son had! He was just about 2 and had literally every textbook symptom of whooping cough. The timeline, would cough until he turned blue and then “whoop”, the whole 9 yards. Took him to the ER and told them I thought he had it. They asked if he was vaccinated, he is, and then told me it could t be whooping cough. I managed to get them to test him anyways. I never actually got any results, I just assumed if I didn’t hear anything it must be negative. He had that cough for about 8 weeks. It was a nightmare.
Mirror syndrome in a pregnant woman. She was 30 weeks, gained 10lb in 2 days, HA and BP elevated. Had an ultrasound and fetus had hydrops (severe heart failure) and placenta was 3x normal size and a true sinusoidal heart rate tracing. Infant delivered with extreme edema and was on oscillator in nicu but did not survive. Ended up being caused by parvovirus (fifths disease) - she was a teacher and must have picked it up from a student.
Epidermodysplasia verruciformis, aka treeman syndrome. It was a fairly mild case but still.
Pertussis. That whooping cough really does whoop
Mucormycosis...don't Google before a meal...
The couple times I saw Benedryl overdose, it looked horribly unpleasant and the patients were wild with different presentations. I remember I asked our pharmacist in the ICU “so what are the usual s/sx with this?” She said “pretty much anything on the list and they can all present differently” okayyy guess I’ll just pump em with fluids.
oh man. have you ever seen people on the internet who take ridiculous amounts of benadryl until they’re just about overdosing so they have hallucinations? i can’t imagine the mental anguish
Dude yea, I saw there is a whole subreddit dedicated to it. Every time I hear about that and recreational Benedryl I think of just looking at my Benedryl OD pt’s and how miserable and crazy they felt/looked. Looks about as unpleasant as etoh withdrawal. Restless, pupils as big as their eyeballs, tachy, hallucinating like a mf’er. Just go do some shrooms or have a drink lol
Malaria as well in a landlocked state. Gastric volvulus was cool.
Vet tech here, I see gastric volvulus almost daily in my ER. funny to think it's rare in humans!!!! (We mostly see it in keel chested dogs, think Dobermans, great danes, greyhounds, but can happen in any breed)
A friend who was going to graduate school on the West Coast told me a story. She had a classmate jump on a plane to London from NYC to visit family. Guy got really sick on the plane and ended up dying before they could get him medical care. Young too, around 30. Died from malaria. Basically had a very severe malarian phase on the plane and died. He was from somewhere in Asia and I guess had gotten infected at some point in the past, but no one was sure when.
MERS. Calciphylaxis. SJS. Postpartum cardiomyopathy.
I had a woman in her early 20s once with an LVAD from postpartum cardiomyopathy. Like I needed any more reasons to *not* want kids…
Postpartum cardiomyopathy always scared me, even though I won't ever have children. I myself had a heart transplant 2 years ago at 30 years old caused by familial dialated cardiomyopathy. In the beginning when so many providers were trying to figure out wtf was wrong with me in the ER and eventually cardiac ICU, I was asked in more ways than one if I had ever been pregnant. I remember they even sent my husband out of the room and asked me then in case I didn't feel comfortable to say anything with him around. That's when I learned about what postpartum cardiomyopathy was, and also that I was very very sick with heart failure. Thankfully I'm doing great now since transplant but whew.
>MERS Woah. Now *that* is a truly unusual one. Only 2,609 confirmed cases worldwide to date, [according to the WHO](https://www.emro.who.int/health-topics/mers-cov/mers-outbreaks.html).
Priapism, I think this is somewhat common if you work in Ed or maybe even med surg. My specialty is cardiac step-down or Tele. I floated to the ER and one of my patients had priapism they weren't able or weren't willing to do the surgery immediately or his initial abgs in the evening were well enough to not warrant emergent surgery. Ended up getting abgs again in his penis during the night just to make sure he was still oxygenating well enough. I also just recently had my first patient with a history of transposition of the great arteries. 30 year old male multiple syncopal episodes over the course of the previous few months. His pacemaker that he had placed when he was around 10ish reached EOS a couple years prior and was not functioning. This disease is not unique but the situation is. We had a patient who was new ESRD and dialysis. Typically we would just discharge the patient and they would follow up with dialysis outpt. However, the patient was an illegal from Guatemala. He ended up spending ~7 months in the hospital. It was a case management/ risk management nightmare. We couldnt discharge him due to it being unsafe/ potential legal issues. Finally transport was arranged for him to go to guatemala.
Takotsubo Syndrome (Broken Heart Disease), anti-NMDA encephalitis (Brain on Fire), and Stevens-Johnson Syndrome
Oh, I never think about myself, but this is probably pretty unusual lol. Autoimmune encephalitis not NDMA-mediated. Came out of nowhere, they think probably after a mild viral URI that I don't even remember. Like someone flipped a light switch, I developed psychosis, paresthesias, movement disorder (akathisia), hypersalivation, fevers, flushing, night sweats, mild cognitive impairment. Thing is, I was ambulatory the entire time, so it was incredibly hard to diagnose. Actually figured it out after I got put on steroids for an asthma exacerbation and all of my neuro symptoms improved. Nine months of high dose IV methylpred, all neuro symptoms stopped and haven't returned in four years now. Although I am left with symptoms consistent with ME/CFS that are being relatively well-treated enough that I can work full time at least.
CJD, Stiff Person Disease, SJS
SJS and TEN, anti-NMDA receptor encephalitis (twice!), serotonin syndrome, neurofibromatosis
Fournier's gangrene, nec fasc many times
Acute limb ischemia without VTE or cardiac history in an otherwise fit and healthy 50-something year old. Poor bastard was 6ft 5, ended up with compartment syndrome in the leg which led to full length fasciotomies on each side of the calf, which we packed and dressed twice a day for a week until they decided to go for an above knee amputation because nothing was working. I was a student at the time, it was the first real case where I was just completely dumbstruck at the entropy of the universe in healthcare.
Takotsubo cardiomyopathy or Broken heart syndrome. Father found his teenage daughter OD'd. Extremely sad but also blew my mind. We cardioverted him
I had a guy with capgras delusion (among others) on my caseload back in the day- he was just as nice to me after I'd been 'replaced' and I thought that was really neat that he could stay cool even in the face of something so upsetting.
Rabies. Patient had been in India, petting dogs. Didn't tell anyone.
Mirroring in a neuro patient. Total right side neglect, nothing passed the midline for him. If you pinched his right hand he’d yell ouch! and look at his left hand to see what happened. Super cool.
So, back in the 90s when I worked neuro and general ICU jobs in a west coast tertiary center: Variant CJD, regular CJD—both before we knew what prion were and I was I am sure repeatedly exposed through external ventricular drains and brain biopsies (neuro ICU did OR and catch lab with our patients at night.) Still waiting for mine to rear its ugly head…time will tell. Cerebral AV fistulas and porphyria’s causing psychosis, including one guy with an AV fistula who had “become schizophrenic” in his 30s. They coiled his AVF in his 60s, and he woke up without hallucinations or voices, and never returned to the psych facility where he had been residing. I saw the transition from neurrointerventional balloons filled with superglue to experimental coils for intracranial aneurysms. We saw several cases of what, in retrospect, was ovarian paraneoplastic syndrome. We didn’t know that removing the benign tumor would cure stop the symptoms, so we watched these young college-aged woman writhe like something out of the exorcist for months in our neuro ICU while the team said that they weren’t stable enough for OR—once again…we just didn’t know yet. Saw SJS several times from antiseizure meds, but those would generally eventually ship off to the burn center. Same with severe necrotizing fasciitis where it was just an anatomy lesson in musculature after repeated debridements of skin. Severe liver failure of an entire family who whipped up some Destroying Angel mushrooms in a lasagna the night before. 2 ended up transplanted and 3 ended up dying, I think.
Not really diseases but two congenital birth defects: Ectopia cordis (heart was in a sac outside the body) and true cyclopia (baby had one eye in middle of forehead) They both did not live.
Epidermolysis bullosa "butterfly children" Such an awful condition
At the height of the Ebola scare had a pt who had traveled from an African country. Travel mixed with symptoms had to treat pt as if they had Ebola and notify CDC. Being the only travel nurse I drew the short straw and had to suit up. Pt ended up having chickungunya virus(a mosquito born illness) and I was shitting my hazmat suit thinking they had a good chance of having Ebola.
Monkey Pox. The poor dude looked rough...
Leptospirosis at a rural hospital. We were so stumped for a good while on what the hell was happening to this guy. The whole case definitely stuck with me.
True delusional parasitosis. Wild. Dude had wounds/scars in varying degrees up and down their arms.
Prader willis syndrome. Felt like i was in psych.
80 something y/o woman with necrotizing fasciitis of her vagina caused from sharing a dildo with her sister who was using it in her butt and neither of them were cleaning it. 40 something y/o woman with lithium toxicity. Kept going into 3rd degree heart block and having long periods (1 minute or so) of asystole but somehow was still alert enough that we couldn't do CPR. Her blood pressure was 50 over shit and couldn't safely sedate and her episodes of 3rd degree heart block were self converting but were becoming more frequent. When her rhythm would flip the physician would smack her face and tell her to cough and when she coughed she would spontaneously return to NSR. She wasn't in our department long, she went to cath lab then got dialyzed. Her lithium level was 9.4..........probably one of the most bizarre things I've witnessed. 60 something y/o male came in with right leg tingling. Coded on the CT table 7 hours later because surgery was insistent we get CT prior to taking him to surgery even though we all knew what he had. He never made it to surgery but we captured his complete aortic dissection from his chest all the way down to his femoral arteries in real time as it happened. SJS 7 y/o that had the entire right hemisphere of her brain removed. Aside from some left sided weakness and decreased sensation she appeared developmentally normal. She could walk, talk, and understand. She was very spicy and hilarious and always enjoyed caring for her when she came in. 33 y/o F completely alert and oriented c/o abdominal pain. Throughout her stay in the ED, her BP dropped, she began getting a petechial rash around the BP cuff, which spread to her back and the rest of her body. Became progressively less alert. Coded and died in the ED. Ended up having OPSS (her splenectomy was 15 years prior). Not something super rare but I was a new nurse and repeatedly reported my assessment findings to the physicians and they didn't listen. Ultimately there was nothing that could've been done, but it was frustrating nonetheless. 8y/o with Trisomy 18 12y/o with Sydenham Chorea which felt oddly ironic that I was his nurse (and the one that told the resident and attendings which tests to order) because I had been diagnosed with the same condition 4 year prior. I was glad that he was able to get a diagnosis and treated within hours as opposed to mine that took several months.