History: 62 y/o man with cirrhosis, presented to the emergency department with the chief complaint of fatigue, dizziness, weight loss, and a tongue lesion. Over the preceding 6 months he states he has had progression of his current symptoms and sought care only after the development of a tongue lesion he noticed 3 weeks prior. He states this lesion is moderately painful particularly while eating or drinking. He has not noticed any discharge from this lesion and it has slowly enlarged. During this time frame he has lost over 80 lbs and he additionally complains of mild shortness of breath and a scant, dry cough. He denies fever, chills or sweats. He has no headache or vision changes. He denies chest pain or palpitations, and has no abdominal pain, diarrhea, constipation, joint pain, or skin rashes.

History: 35yr old male with a past medical history of hemophilia A and IgA nephropathy complicated by end stage renal disease on peritoneal dialysis status post failed deceased donor kidney transplant presented to the emergency room with diffuse and sharp abdominal pain. The patient was in his usual state of health until three days prior to admission when he developed abdominal pain surrounding his peritoneal dialysis catheter site. His pain progressed in severity and was associated with significant nausea and “cloudy” catheter effluent. He states he has had chronic pruritus surrounding the catheter site and frequently attempts to scratch this area.