I thought I should bring up few interesting internal medicine problems to the attention and discussion of this forum. I am introducing the first of these interesting cases below: A 39-year-old intravenous drug abuser was admitted through the Emergency Department with left shoulder and abdominal pain without any history of trauma. He reported self-injection of a bolus mix of heroin and cocaine into his groin on the day of admission. Initial examination was unremarkable, and the radiographs of the chest and left shoulder and routine blood tests were all normal.
A few hours later he fainted while getting up from bed, became hypotensive, with a drop in hemoglobin level of 3 g/dL (from 13.5 g/dL at admission) without any evidence of overt bleeding. A bedside echocardiography was normal. An ultrasonography of the abdomen revealed a splenic length of 12.5 cm, with a hypoechogenic texture…
