Groin pain 3 weeks followed by painful maculopapular rash radiating to lower back with splenomegaly and ascites. Thrombocytopenia, elevated ESR  and CRR. Derm consulted suspicion of T-cell lymphoma 

Panniculitis - occurs in fatty parts of the body, usually painful. Different types based on pathology. 

HTLV-1 - retrovirus classically in African, Caribbean populations. Mainly asymptomatic. But can present as T-cell lymphoma picture with blastic body lesions (hypercalcemia) or Tropical spastic paresis. Classic finding is flower cells (lymphocytes look like a tulip). 

Celiac disease: can cause iron deficiency anemia, celiac antibodies (tTG-IgAs need to get total IgA levels, if total IgA low get IgG-tTG.  Rare complications= Celiac encephalitis. Refractory spur which requires steroids

ZES/gastrinoma = gastric elevated, multiple duodenal ulcers, diarrhea 2/2 osmotic diarrhea. Secretin test is diagnostic 

Dieulafoy lesions = arterial, fast squirting bleeds 

Systemic sclerosis can present as uncontrolled pain (IPF)

Hypothyroidism associated with OSA, high CPK 2/2 muscle weakness and pericardial effusion 

Myxedema give steroids with IV synthroid within first 24 hours. When giving IV synthroid keep in mind metabolic rate will increase and also coronary demand so in elderly start smaller doses (t3 is the active form)

Hypothyroidism associated with Autoimmune polyendocrine syndrome= Autoimmune adrenitis with hashimotos thyroid and/or type 1 DM

Acute pericarditis diffuse ST elevation in no vascular territory. Cause post viral, post-MI, autoimmune, FMF. Tx colchicine if not given you can get amyloid 

Medullary sponge disease (dx by imaging, cysts in medulla) not likely to require dialysis. Polycystic kidneys likely requires dialysis

Psychogenic seizures treatment =CBT

Catatonia can have various presentations (hypokinetic, hyperkinetic, mixed). Malignant catatonia (high fever, fast heart rate, autonomic instability) is a variant which is life-threatening 

Rheumatoid vasculitis can cause polyneuropathy 

TB meningitis you will see elevated ADA in CSF