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Article History

Received: 7 March 2016

Revised: 26 May 2016

Accepted: 23 June 2016

First Online: 25 July 2016

Compliance with Ethical Standards

:

: None.

: The case was presented at a noon conference clinical problem-solving unknown discussion at the Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, Alabama. The clinical information and case discussion closely reflect the topics discussed.

: The authors declare that they do not have a conflict of interest.

: The opinions expressed in this article are solely those of the authors and do not reflect the views of the Department of Veterans Affairs.