A Diagnostic Dilemma: A Case of Complicated Pneumonia With Pyelonephritis and Subclinical Myocarditis.

A 41-year-old woman presented with a 3.5-month history of fever, weakness, productive cough, and burning micturition along with generalized weakness and significant weight loss. Chest X-ray revealed bilateral infiltrates and bilateral pleural effusion, and the workup suggested community-acquired pneumonia (CAP). However, the course was complicated by persistent fevers, elevated inflammatory markers, elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), and pelvic fluid collection. Extensive investigations, including bronchoscopy and lung biopsy, failed to identify a specific pathogen. Pulmonary vasculitis and lymphoma were ruled out. Antibiotic and corticosteroid therapy resulted in clinical improvement. While the cause remains unknown, brucellosis and aspergillosis were considered but ruled out with advanced testing. The underlying etiology remains elusive, highlighting the diagnostic challenges in CAP with atypical presentations.

A Rare Presentation of Systemic Lupus Erythematosus (SLE) With Hemoptysis and Hematuria: A Case Report.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by type II and type III hypersensitivity reactions that affect multiple organs, including the joints, heart, lungs, brain, skin, and kidneys. Patients with SLE can experience a range of symptoms, ranging from fever and joint pain to a distinctive butterfly facial rash. Severe complications may encompass conditions such as diffuse alveolar hemorrhage (DAH), pulmonary hypertension, and lupus nephritis, among others. Among them, DAH, a critical pulmonary complication in SLE, involves bleeding from interstitial capillaries and alveoli due to immune complex damage. This case report describes a patient who was initially misdiagnosed but later confirmed to have SLE. The patient presented with persistent symptoms, including cough, dyspnea, and fever, over two weeks and subsequently developed hematuria and hemoptysis within the last two days. The progression of symptoms led to an acute exacerbation, resulting in her admission to the emergency department. Subsequent evaluations confirmed the diagnosis of lupus nephritis and DAH. This case highlights the importance of considering SLE in the differential diagnosis of unexplained systemic symptoms and underscores the urgent need for medical intervention in DAH to substantially reduce mortality.

Left Ventricular Non-compaction and Associated Cardiomyopathy Presenting With Cardiac Failure: A Case Report.

The characteristic structural anomaly of the heart in the left ventricular non-compaction (LVNC) is identified with a prominent layer of the trabecular meshwork, thin compacted myocardium, and intertrabecular recesses within the depths of the left ventricle. Despite growing clinical recognition, the prevalence of LVNC in adults and the full clinical spectrum remain poorly explored. The disease shows heterogeneous phenotypes from an asymptomatic presentation to severe cardiac complications like cardiac failure, arrhythmias, and thromboembolic events. Current diagnostic practices for LVNC lack standardized guidelines, making patient management difficult. We here report a case of an adult patient who presented with features of congestive cardiac failure and on detailed imaging with echocardiogram and magnetic resonance imaging (MRI) was diagnosed to have LVNC. We here also emphasize that there is a great need for refined diagnostic criteria that include genetic, clinical, and imaging data. Cases of LVNC with full-blown phenotypic expression should be used for diagnostic criteria.

Navigating Infertility in Kartagener's Syndrome: A Clinical Case Report.

Kartagener's syndrome is a genetic condition that is caused by a triad of symptoms, which includes bronchiectasis, chronic sinusitis, and situs inversus, and is considered rare. It is caused by defective ciliary motility, leading to impaired mucociliary clearance. We report a case of a 24-year-old male who presented with primary infertility and a long-standing history of recurrent respiratory infections. Physical examination revealed dextrocardia and digital clubbing. Radiological investigations confirmed situs inversus totalis and bronchiectasis. Semen analysis revealed azoospermia. Genetic analysis was not done due to financial constraints. However, the constellation of clinical features was diagnostic of Kartagener's syndrome. The patient was managed with antibiotics and chest physiotherapy. In vitro fertilization (IVF) was advised for infertility. A successful pregnancy was achieved through IVF, indicating viable sperm despite immotility. The aforementioned case underscores the significance of maintaining a heightened sense of suspicion for Kartagener's syndrome in individuals exhibiting unexplained bronchiectasis and infertility. Early diagnosis can prevent chronic respiratory morbidity and enable parenthood through assisted reproduction.

The Psychosocial Effects of Lockdown Due to the COVID-19 Pandemic on Children in 2021.

Objectives The COVID-19 pandemic led to a nationwide lockdown that isolated numerous children and adolescents, significantly affecting their mental well-being. Therefore, this study aimed to assess the challenges faced by children during the pandemic and identify the potential contributing factors. Additionally, given the existing concerns surrounding the mental health of female children and adolescents, our study aimed to investigate the presence of sex-based disparities in children's observed emotional and behavioral difficulties during the COVID-19 lockdown. Methods Participants in this study were parents of children aged 6-17 years. An observational cross-sectional study was conducted through verbal administration of a validated semi-structured questionnaire, the Parent Report Measure, from June 2021 to August 2021 at a nearby community health center. The questionnaire collected socio-demographic details and utilized the Strengths and Difficulties Questionnaire (SDQ), a screening tool to assess children's emotional and behavioral aspects during the six-month lockdown period. The responses were then analyzed using appropriate statistical tools like SPSS statistics, and cumulative SDQ scores were used to categorize participants. Results Out of the total 280 responses analyzed, the prosocial subscale exhibited the highest number of abnormal responses, 73 (26.1%), followed by conduct (42; 15%), hyperactivity (41; 14.6%), and peer (41; 14.6%) subscales. These results indicated that children displayed decreased empathy towards others, restlessness, fidgetiness, reduced attention span, frequent tantrums, and a preference for solitary activities. Furthermore, there was a significant association between abnormal subscale scores and the sex of children. Females showed a considerably higher prevalence of emotional problems (172; 61.5%) than males. Among the behavioral responses, a more significant proportion of females displayed abnormal scores in the conduct subscale (170; 60.7%), while abnormal hyperactivity scores were more frequently observed among males (178; 63.4%). Regarding the peer problems subscale, the proportion of females was slightly higher than males (150; 53.7%) and nearly equal in the prosocial domain. A more significant proportion of females displayed abnormal scores for overall difficulties 144 (51.5%), indicating a notable sex-based disparity. Conclusion Our findings highlight the pandemic's significant impact on many children's psychological well-being. The results emphasize the need for targeted interventions to address the mental health concerns that arose in this population. The observed disparity in emotional and behavioral difficulties among female children is particularly concerning, highlighting the need for gender-sensitive support and care. Various strategies can be helpful, such as virtual support groups, indoor recreational activities, reduced screen time and excessive news consumption, and effective communication with parents. Furthermore, our study also indicates the need to dive deep into such areas of pediatric research to understand and plan timely interventions.

Dysphagia in a Patient With Lewy Body Dementia and Incidental Anterior Cervical Osteophyte: A Case Report.

One of the common problems affecting the elderly is dysphagia, which can be brought on by several things, including the presence of anterior cervical osteophytes. In this case study, a patient with Lewy body dementia is shown to have a case of dysphagia. The patient's primary complaint was dysphagia, which prompted questions regarding the development of underlying Lewy body dementia combined with gradual cognitive deterioration and motor control problems. An upper GI endoscopy was conducted during the patient's hospitalization after a barium swallow suggested esophageal obstruction but found no internal obstruction or any other abnormalities. Following the endoscopic procedure, the patient complained of neck aches. An anterior cervical osteophyte was subsequently discovered by computed tomography, which may have been the primary cause of the patient's dysphagia. The importance of considering coexisting medical conditions in elderly individuals, as well as the significance of promptly assessing and diagnosing dysphagia in the presence of neurodegenerative disorders such as Lewy body dementia, is emphasized by this example.

Adrenaline, Takotsubo, Anaphylaxis, and Kounis Syndrome (ATAK) Complex Unveiled: Integrating Takotsubo and Kounis Syndromes in the Context of Chemotherapy-Related Anaphylaxis.

The convergence of takotsubo and Kounis syndromes, collectively referred to as the "ATAK complex" (short for adrenaline, takotsubo, anaphylaxis, and Kounis syndrome), poses a unique and challenging clinical scenario, especially in the context of chemotherapy-related anaphylaxis. We present a case report involving a 63-year-old woman undergoing chemotherapy for endometrial adenocarcinoma who experienced anaphylactic symptoms during treatment. Immediate administration of epinephrine was followed by the emergence of ST elevation, a reduced left ventricular ejection fraction, and wall motion abnormalities indicative of stress-induced cardiomyopathy. Detailed investigations revealed normal coronary arteries, prompting further exploration into the intricacies of the ATAK complex. Notably, the administration of intravenous rather than intramuscular epinephrine was identified as a contributing factor. This case underscores the critical importance of recognizing and managing the ATAK complex promptly, emphasizing the need for refined diagnostic and treatment guidelines. The interplay between adrenaline, takotsubo, anaphylaxis, and Kounis syndrome necessitates a nuanced approach, urging healthcare professionals to exercise caution and adhere to recommended administration routes. Increased awareness of the ATAK complex is imperative for optimizing patient outcomes and guiding therapeutic interventions in similar clinical scenarios. Further research is warranted to elucidate the underlying mechanisms and refine strategies for the effective management of this intricate syndrome.

A Cardiovascular Conundrum: A Case of Excessive Exercise Masquerading as a Heart Attack.

Cardiac troponins T and I are sensitive biomarkers often associated with acute coronary syndrome but can also be elevated after intense exercise, posing diagnostic challenges. We present the case of a 42-year-old male cyclist who complained of chest pain during exercise with elevated troponin levels. A comprehensive evaluation ruled out cardiac pathology but revealed acid reflux. Excessive cycling posture exacerbates reflux, likely contributing to chest pain and troponin elevation. This case underscores the importance of considering alternative etiologies in athletes with chest pain and elevated troponin levels after extreme exertion. It also highlights the role of antireflux therapy and activity modification in managing such cases. Further research is needed to elucidate the long-term cardiac effects of exercise-induced troponin elevation, although this is currently considered a reversible physiological phenomenon.

Holistic Approaches to Arrhythmia Management: Combining Medication, Ablation, and Device Interventions.

This narrative review investigates the severe health issue of arrhythmias, which affects millions of people worldwide. A multifaceted strategy incorporating medicine, catheter ablation, and advanced device interventions is necessary to manage these disorders effectively. Medication is the cornerstone, and as antiarrhythmic medications develop, their efficacy and side effects are reduced. Success depends on having individualized treatment strategies that consider patient profiles and arrhythmia type. Catheter ablation, a minimally invasive surgery that targets and removes faulty heart electrical circuits, has become a potent therapy when drugs are ineffective. Technological developments, including high-resolution mapping systems and customized catheters, improve precision. Pacemakers and implantable cardioverter-defibrillators (ICDs) are two examples of implantable cardiac devices essential to managing all types of arrhythmias. Pacemakers provide a regular heartbeat when the body's natural pacing mechanism fails. At the same time, ICDs, with cutting-edge algorithms, can identify and stop life-threatening arrhythmias and offer high-risk patients vital protection. As device technology advances, smaller, more durable devices become available, improving patient comfort and lowering the need for replacements. The seamless fusion of these three strategies is where holistic arrhythmia management shines. Even for difficult instances, customized combination therapy combining medicine, ablation, and device interventions offers complete solutions. Healthcare providers must collaborate for this integrated strategy to deliver personalized, efficient, and holistic care. In conclusion, the management of arrhythmias has developed into a dynamic, synergistic discipline where drugs, catheter ablation, and devices all work in concert to deliver comprehensive care. For those with arrhythmias, a patient-centered strategy that considers their particular patient features and best integrates different modalities can significantly enhance their quality of life. The effectiveness and accessibility of holistic arrhythmia management could be further improved because of ongoing developments in these fields, which is encouraging for patients and medical professionals.

Phenytoin-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Overlap in Focus: A Case Report.

Stevens-Johnson syndrome and toxic epidermal necrolysis overlap is a rare but severe cutaneous hypersensitivity reaction that can lead to death if not treated aggressively and adequately. Drug-induced hypersensitivity reactions are often related to drug exposure, with sulfonamides, anti-epileptics, fluoroquinolones, cephalosporins, and nonsteroidal anti-inflammatory drugs being the most common culprits. This case report describes a 10-year-old boy who was administered phenytoin at a local clinic to manage his seizures. This treatment led to the onset of SJS-TEN overlap, ultimately resulting in his demise.

Cardiac Rehabilitation in the Modern Era: Optimizing Recovery and Reducing Recurrence.

Cardiovascular diseases (CVDs) continue to be a prominent issue in global health, emphasizing the necessity for efficient cardiac rehabilitation programs. This narrative review provides a detailed analysis of the current state of cardiac rehabilitation, focusing on maximizing recovery and minimizing the likelihood of recurrence. This paper examines the historical progression of cardiac rehabilitation, explores the epidemiological background of cardiovascular disease (CVD), and provides an overview of the many stages of the rehabilitation process. The assessment of patients plays a crucial role in healthcare, serving as a fundamental basis that incorporates medical, psychological, and social aspects. The utilization of risk stratification techniques further enhances this process. The present study investigates exercise training, particularly emphasizing the current recommendations and the mutually beneficial effects of aerobic and resistance regimens. In addition to physical therapies, this study emphasizes the importance of nutrition, lifestyle adjustments, and the significant effects of medication. Psychosocial assistance is a crucial element that addresses the significant psychological effects of cardiac disease and provides comprehensive techniques for overall well-being. Technological advancements are significantly transforming the domain of cardiac rehabilitation, encompassing the integration of wearable technologies and telemedicine solutions. The convergence of artificial intelligence and data analytics can enhance the customization of healthcare services. Through a comprehensive rehabilitation program, patients can achieve an improved quality of life and enhanced functional outcomes. However, it is essential to acknowledge that obstacles still hinder individuals from accessing and completing educational programs. Therefore, it is crucial to engage in a discourse on potential tactics that may be employed to address these issues, considering the various cultural and socioeconomic aspects that contribute to them. The analysis focuses on the economic dimension, examining the cost-effectiveness of rehabilitation programs and their congruence with healthcare policies. In anticipation of future developments, the study provides valuable perspectives on the prospective trajectory of cardiac rehabilitation. It delves into nascent patterns and examines the potential ramifications of precision medicine and genetics for tailoring treatment strategies to individual patients. In brief, this narrative review comprehensively examines the various dimensions of contemporary cardiac rehabilitation. It offers a comprehensive perspective on its significance in enhancing recuperation and mitigating the likelihood of the recurrence of cardiovascular ailments. The significance of this review lies in its ability to enhance patient outcomes, thereby making a valuable contribution to the worldwide endeavor to address the burden of cardiovascular disease.

Individualizing Medicinal Therapy Post Heart Stent Implantation: Tailoring for Patient Factors.

The field of cardiovascular medicine is undergoing a transformative shift towards personalized medicinal therapy, particularly in the context of post stent implantation. This narrative review explores the significance, challenges, and future directions of individualized treatment strategies for patients with coronary stents. The review highlights the pivotal role of personalized approaches in optimizing treatment efficacy and minimizing adverse events. Real-world clinical studies and trials underscore the importance of tailoring antiplatelet therapy based on platelet function testing, genetic testing, and risk scoring. These studies reveal that personalized medicinal treatment improves clinical outcomes by balancing preventing thrombotic events and mitigating bleeding risks. Challenges, including cost, test availability, patient adherence, and ethical considerations, are discussed in depth, shedding light on the complexities of implementing personalized approaches. Technological advancements, including omics data integration, artificial intelligence, and big data analytics, shape the future of personalized medicinal therapy. These tools enable precise pharmacogenomic selection of medications and the development of integrated risk-scoring systems. Patient engagement and education are also central, with empowered patients and remote monitoring contributing to collaborative decision-making. In conclusion, the narrative review underscores that personalized medicinal therapy post stent implantation holds immense promise for revolutionizing cardiovascular care. By embracing a comprehensive approach that considers genetics, clinical factors, and patient preferences, healthcare providers can optimize treatment outcomes and improve patient quality of life. The evolving landscape of personalized medicine offers a glimpse into a future where tailored treatment strategies become the cornerstone of precision cardiovascular care.

Innovative Approaches and Therapies to Enhance Neuroplasticity and Promote Recovery in Patients With Neurological Disorders: A Narrative Review.

Brain rehabilitation and recovery for people with neurological disorders, such as stroke, traumatic brain injury (TBI), and neurodegenerative diseases, depend mainly on neuroplasticity, the brain's capacity to restructure and adapt. This literature review aims to look into cutting-edge methods and treatments that support neuroplasticity and recovery in these groups. A thorough search of electronic databases revealed a wide range of research and papers investigating several neuroplasticity-targeting methods, such as cognitive training, physical activity, non-invasive brain stimulation, and pharmaceutical interventions. The results indicate that these therapies can control neuroplasticity and improve motor, mental, and sensory function. In addition, cutting-edge approaches, such as virtual reality (VR) and brain-computer interfaces (BCIs), promise to increase neuroplasticity and foster rehabilitation. However, many issues and restrictions still need to be resolved, including the demand for individualized treatments and the absence of defined standards. In conclusion, this review emphasizes the significance of neuroplasticity in brain rehabilitation. It identifies novel strategies and treatments that promise to enhance recovery in patients with neurological illnesses. Future studies should concentrate on improving these therapies and developing evidence-based standards to direct clinical practice and enhance outcomes for this vulnerable population.

Black Tongue: A Rare Presentation of Rhupus Syndrome.

Black tongue is a benign condition typically caused by the overgrowth of dead skin cells, resulting in elongated papillae and a hairy appearance. Other factors contributing to this condition include inadequate oral hygiene, a soft diet, and staining from bacteria, food, yeast, and other substances. It may cause symptoms such as bad breath, a metallic taste in the mouth, and an unsightly black hairy-looking tongue. Here, we present a case of a 30-year-old female who came to our hospital complaining of bad breath and a black tongue for the past month. She had previously taken antibiotics at the primary care medical center, but there was no improvement. We then prescribed her fluconazole, an antifungal medication, for the next two weeks. After two weeks, she returned with a slightly improved tongue color. Further investigation revealed a history of abortion and mild intermittent joint pains, for which she had been self-medicating with over-the-counter acetaminophen. A complete work-up led to the discovery of positive anti-cyclic citrullinated peptide (anti-CCP) antibodies, anti-double-stranded (anti-DS) DNA antibodies, and ANA, leading to the diagnosis of Rhupus Syndrome, an overlap of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).

COVID-19 Rekindling Herpes Zoster in an Immunocompetent Patient.

During the coronavirus 2019 (COVID-19) pandemic, sundry dermatological conditions related to COVID-19 pneumonia have been published. COVID-19 primarily affects the respiratory system, but secondarily it also affects the heart, kidney, brain, skin, spinal cord, etc. Herpes Zoster (HZ) is considerably important morbidity associated with COVID-19 pneumonia. Recrudescence of HZ occurs because of the latent varicella-zoster virus (VZV) predominantly because of the decline in cell-mediated immunity (CMI). Abating CMI is due to the increasing age, but could also occur if the patient is suffering from an immunosuppressive disease or is using immunosuppressive drugs. In our case, the patient had no lymphopenia unlike the other cases, yet still, he developed HZ. HZ is associated with post-herpetic neuralgia (PHN), HZ ophthalmicus (HZO), and cerebral arteritis increasing morbidity and mortality, especially in elderly people and those who are immunocompromised.

Delayed Diagnosis of Neck Pain: Eagle Syndrome.

Eagle syndrome is a rare condition characterized by an abnormally elongated styloid process with or without abnormal direction and/or ossification of the styloid ligament. Clinically, it consists of throat and neck pain radiating to the ear. Here, we present the case of a 34-year-old female with the complaint of left-sided neck pain below the ear for the past year. The patient had tried different analgesics after seeing different doctors, but the pain did not resolve. After conducting radiological investigations at the hospital, a diagnosis of Eagle syndrome was made. The patient was treated with surgical styloidectomy, followed by subsequent remission of the symptoms.

First Case of Enterovesical Fistula Caused by Ischaemic Enteritis.

We present the case of an enterovesical fistula (EVF) caused by ischemic enteritis. Ischemic enteritis is caused either by mesenteric macrovasculature occlusion or any pathophysiologic vasospasm of the microvasculature. In other words, ischemic enteritis (IE) occurs when the inflow of blood to the small intestines is reduced. The frequency of ischemic enteritis is less as compared to ischemic colitis because of the vast blood supply to the small intestine. It is the first case to be reported in the medical literature to date. EVF is a rare entity. It is a pathological connection between the bowel loops and the urinary bladder. EVF is a result of an underlying disease or injury. EVF is mostly caused by diverticular diseases, carcinoma colon, Crohn's, and inflammatory bowel disease, iatrogenic, appendicitis, carcinoma cervix, etc. Due to the formation of this abnormal connection, contents of the intestines, including the air, food content, etc., are usually found in the urine. Patients usually present with the complaint of irritative urinary tract symptoms and recurrent urinary tract infection (UTI). Surgical management is the mainstay of treatment although medical management is tried for those who cannot bear to undergo surgery.

Antibiomania: A Rare Case of Metronidazole-Induced Mania.

Metronidazole is a very commonly used drug for the treatment of ailments caused by bacteria and parasites. It can treat a vast array of conditions like rosacea, sexually transmitted diseases (STDs), liver abscess, bedsores, etc. Metronidazole comes with generic side-effects like nausea, vomiting, dizziness, metallic taste, and also rare side-effects like paresthesia, syncope, cerebellar symptoms, psychosis but mania is a rare side-effect. Here, we present a case of metronidazole induced mania in a 50-year-old male with no past medical history who initially presented with a complaint of mild fever, loss of appetite, and fatigue from the past 10-12 days. On further examination and investigations, diagnosis of the amebic liver abscess was made on the basis of USG, serum serology for amebiasis IgG, and a CT scan. Consequently, the patient was started on the drug of choice for amebic liver abscess; IV metronidazole 1.5g/day divided over the day into three doses. Other drugs that were administered were pantoprazole, paracetamol, and ondansetron. On the ninth day of admission, the patient's wife as well as the physician-daughter of the patient reported a change in the behavior of the patient which became a major concern for the family. The patient was restless, energetic, unable to sleep, had racing thoughts, elated mood, petulant, and kept singing loudly in the private patient room. There was no history of any psychiatric illness in the family. Mr. K´s manic symptoms were managed using haloperidol and lorazepam. Upon discontinuing metronidazole, there was a gradual improvement in the manic symptoms, and symptoms improved, haloperidol and lorazepam were able to be tapered down and eventually stopped. Mr. K did not require any use of any selective serotonin reuptake inhibitor (SSRIs), monoamine oxidase inhibitors (MAOIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), or any other atypical psychotropic drug. Manic-psychosis side-effect is a rare entity caused by antibiotics and the symptoms of which would disappear in a few days after stopping the antibiotic. It is also notable that this patient recovered without the use of any psychotropic drugs. Physicians should be aware of the possible neuropsychiatric side-effects of antibiotics which can lead to unnecessary workup. This side-effect did not require the use of any psychotropic drugs in this patient.

Neurocysticercosis: An Easy to Miss Diagnosis in Non-Endemic Regions.

A 29-year-old male presented with swollen gums and stomatitis for the past two months. History revealed that he had moved to the United States from India six years ago and had a first episode of generalized tonic-clonic seizure with confusion and loss of consciousness. Meningioma of the brain was diagnosed, and a Gamma Knife excision of the meningioma was planned. The patient refused to proceed with the surgery and came back to India for a second opinion. Upon repeat MRI scan, the neurosurgeon revised the diagnosis to neurocysticercosis (NCC), and the patient was treated with albendazole, prednisolone, and phenytoin and recovered completely. Hence an unnecessary brain surgery was avoided. The complaint of stomatitis and gingival hypertrophy was due to the side effects of phenytoin. NCC remains a major public health problem in developing countries, and it should be considered as a differential diagnosis in patients from NCC endemic regions.

Consequences of a Missed History: A Case of Antidepressant Discontinuation Syndrome.

Antidepressant discontinuation syndrome (ADDS) is reported to occur in almost 30-50% of the patients who take antidepressants for a duration of at least four to six weeks and then suddenly discontinue the drug. Since there is an increase in the use of antidepressants for various reasons by general practitioners, patient education about when and how to discontinue a drug is not acknowledged enough. It is reported to occur with the use of different classes of antidepressants - selective serotonin reuptake inhibitor (SSRI), monoamineoxidase inhibitor (MAOI), tricyclic antidepressants (TCAs), and atypical antipsychotics like risperidone, trazodone, clozapine, and venlafaxine. Slow tapering off the drugs has also caused ADDS. Symptoms start within two to four days of quitting the drug and are usually mild lasting for two to four weeks (can persist for six to 12 months) but could be severe enough leaving the patient nonambulatory. Here, we represent a case of a 55-year-old female who presented to the outpatient clinic with complaints of headache, vomiting, and diarrhea. The patient had 10 to 12 episodes of watery diarrhea every day and bilateral, continuous, pressing headache associated with multiple episodes of non-projectile vomiting. She was investigated for ultrasound sonography (USG) abdomen, CT head, and lab investigations which turned around to be normal. A follow-up visit with detailed history revealed she suddenly stopped taking escitalopram after six months by herself without tapering off the dose, two days before the onset of symptoms. Escitalopram was reinstated and the symptoms started to resolve in two to three days. All the unnecessary investigations and treatment could have been prevented if the proper history was taken and revealed at the initial visit.