The authors herein present the case of a 53-year-old female who was being treated, as an outpatient, for seizure disorder but was also receiving high dose Methadone therapy. She presented to the Emergency Department for what appeared to be a seizure and was found to have a prolonged QTc interval as well as runs of paroxysmal polymorphic ventricular tachycardia with seizure-like activity occurring during the arrhythmia. The markedly prolonged QTc interval corrected after treatment with intravenous magnesium, and subsequent EEG, neurologyand cardiology consultations revealed the cause of the recurrent seizure-like episodes to be secondary to the cardiotoxic effects of methadone.

Alveolar hemorrhage is a rare yet devastating clinical entity if not identified and treated aggressively. Exceedingly rare are the cases of anticoagulant-induced alveolar hemorrhage with very few cases described in the current literature. The nonspecific presentation of an alveolar hemorrhage makes its diagnosis and appropriate treatment difficult in the emergency department. We report a case of a patient on warfarin for atrial fibrillation who was initially misdiagnosed as having community-acquired pneumonia, but subsequently was identified to have a fatal alveolar hemorrhage.