The Louisiana State Medical Society was formed in 1878 with the sole purpose of advancing "healthcare in the state of Louisiana. Today our mission is to be the trusted advocate for patients and physicians in the State of Louisiana. Learn more about the history of LSMS here: https://lsms.org/page/History.
ABSTRACTS FROM THE 2025 LOUISIANA ANNUAL ACP MEETING
CONTENTS
JOURNAL EDITORIAL STAFF ASSOCIATE EDITOR L.W. Johnson, MD CHIEF EXECUTIVE OFFICER Jeff Williams JOURNAL EDITORIAL BOARD Vice Chair, K. Barton Farris, MD Secretary/Treasurer, Richard Paddock, MD Anthony Blalock, MD
5 Abstract Winners ORAL PRESENTATIONS – RESIDENTS: SESSION 1 6 Neuroendocrine Tumors: Endocrine Insights in a Case of Chronic Diarrhea 6 Mystery of Madness: Unraveling a rare cause of common psychiatric symptoms 7 A Rare Presentation of Hereditary Cholestatic Liver Disease in a Young Adult Patient 8 Pickering Syndrome. 8 Systemic Lupus Erythematosus presenting with Severe Mixed Auto-immune Hemolytic Anemia 9 Bad Blood: A rare case of paraneoplastic Acquired Hemophilia A (AHA) in an elderly individual ORAL PRESENTATIONS – RESIDENTS: SESSION 2 10 Sarcoidosis and IgA Nephropathy: An Emerging Association. 10 An Electrical Storm of the Heart. 11 Paradoxical embolism to the coronary arteries: an uncommon cause of acute Myocardial Infarction 12 The Unexpected Villain: A Case of Acute Epiploic Appendagitis in a Young Male with Acute Abdomen 12 Exploring Metastatic Pathways: Neuroendocrine Carcinoma of the Lung with Liver and Adrenal Gland Involvement. MYSTERY CASE PRESENTATIONS – RESIDENTS 14 Paraneoplastic Anti-NMDAR Encephalitis: Mystery with an Ovarian Teratoma Twist 14 Kommerell Diverticulum: A rare vascular anomaly causing nonspecific chest pain POSTER PRESENTATIONS – RESIDENTS 16 Turning the Tide: The Impact of Early Intervention with Steroids on Patient Outcomes in non-COVID pneumonia, Insights from a case. 16 Teeth of Truth: A Sjogren’s Journey. 17 A Broken, Spastic Heart: Case of Takotsubo Cardiomyopathy Complicated by Vasospastic Angina. 18 The Irony! Self-induced Hyperkalemic Emergency in Primary Hyperaldosteronism. 18 Precipitation of Acute Myopericarditis by Diabetic Ketoacidosis. 19 A rare and unusual case of Rheumatoid Vasculitis after short term cessation of maintenance medications. 20 An Airway Watch: A case of Laryngeal Kaposi’s Sarcoma. 20 A Rare Case of Cardiomyopathy Associated with Streptococcus anginosus and Fusobacterium necrophorum.
L.W. Johnson, MD Fred A. Lopez, MD LSMS 2024 BOARD OF GOVERNORS OFFICERS OFFICERS President, Roderick Clark, MD Immediate Past President, Richard Paddock, MD President-Elect, Steen Trawick, MD Secretary - Treasurer, Amberly Nunez, MD Speaker, R. Reece Newsome, MD Vice Speaker, Katherine Williams, MD Col, Chair, Matthew Giglia, MD Ex Officio, Lampac, Chair, Susan Bankston, MD COUNCILORS
District 1 Member, Myra Kleinpeter, MD District 2 Member, Luis Arencibia, MD District 3 Member, Allen Vander, MD District 4 Member, Randall White, Jr., MD District 5 Member, Gwenn Jackson, MD District 6 Member, Michael Roppolo, MD District 7 Member, Donald Higgins, MD District 8 Member, VACANT District 9 Member, Andy Blalock, MD District 10 Member, Michele Cooper, MD SECTION REPRESENTATIVES
Medical Student Section Member, Gregory Laborde Resident/Fellow Section Member,Omar Leonards, MD Young Physician Section Member, Ken Ehrhardt, MD Employed Physician Section Member, Clay Runfalo, MD Private Practice Physician Section Member, Lance Templeton, MD
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CONTENTS CONTINUED
21 Severe Acute Liver Injury in the Setting of Congestive Hepatopathy: A Rare Case of Cardiac-Induced Hepatic Dysfunction. 22 A Symphony by Streptococcus pyogenes. 22 Achromobacter Xylosoxidans bacteremia in a hemodialysis patient with AV graft infection: A Case Report. 23 Acute Abdominal Pain as a Rare Presentation of Membranous Nephropathy: Case of Superior Mesenteric Vein Thrombosis. 23 An Atypical Presentation of Prosthetic Valve Endocarditis: A Case of Staphylococcus haemolyticus. 24 An Interesting Case of Shewanella Algae Bacteremia. 25 An Unusual Case of Profound Hypothyroidism Leading to Rhabdomyolysis in Chronic Kidney Disease. 25 Aortic Stenosis: A Risk Factor for Pseudomembranous Colitis.
37 Invasive Aspergillosis Without a Known Immunodeficiency 37 A Rare Case of Large Cell Neuroendocrine Carcinoma of the Lungs in a young guy with minimal smoking history 38 Ischemic Stroke, Infection, or Autoimmune? A Case Report Highlighting the Challenges to Diagnose MOGAD “Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease 38 IVIG with steroids Successfully Halt a Recurrent Hyperhaemolysis Syndrome in a Young Patient with Sickle Cell Crisis 39 Leptospirosis: An Uncommon Cause of Fever and Transaminitis in the Continental United States 40 Marantic Endocarditis: A Rare Complication of Endometrial Adenocarcinoma 40 Tamoxifen -induced Lupus Erythematosus in Breast Cancer. 41 MedVet: Working towards a permanent solution to improve handoff at the VA 42 Miller Fisher Syndrome 42 MRSA Bacteremia Leading to Endogenous Bacterial Endophthalmitis in a 76-Year-Old Female with Complex Medical History 43 Opioid-Induced Intrahepatic Cholestasis in Hemoglobin SC Disease: A challenging issue in management 43 Pacemaker Syndrome - A Dyssynchronous Future 44 Pleural effusion resulting in RV collapse and pre-tamponade physiology 45 Probable Neurosarcoidosis – A Rare Diagnosis in a 56-year-old Female with Facial Nerve Palsy 45 Purple Rain: A Rare Case of Purple Urine Bag Syndrome 46 Rapidly Progressive Case of Neuromyelitis Optica Spectrum Disorder 47 Recurrent Intravascular Tumor Invasion in Right Atrium: A Rare Complication of Metastatic Renal Cell Carcinoma 47 RET Mutated Non-Small Cell Lung Cancer (NSCLC) in Association with Patients from Central America 48 Right Arm Fractures and Edema in the Setting of High-Grade Neuroendocrine Carcinoma 49 Salicylate Overload: A Case of Chronic Salicylate Poisoning 49 Stepping Into Trouble: A Case Of Pseudomonas Mendocina Bacteremia 50 Sleight of Hand- A Case of Mycobacterium marinum Tenosynovitis 51 Splash, Soak, and Symptoms: A Surprising Diagnosis of Leptospiral Meningitis 51 Statin-Induced Myopathy: A Case of Resolution 3
26 Case of Stubborn Keratoconjunctivitis! 27 Case-Based Approach to Management of Common On-Call Scenarios. 27 Clostridium cadaveris Bacteremia – A Link Between Life and Death. 28 Code Blue Green: Inclusions Of Doom. 28 Cryptococcal Meningitis Mimicking Metastatic Brain Disease: A Diagnostic Challenge.
29 Decoding VEXAS: The Hidden Challenges of Inflammation. 30 Osmotic demyelination syndrome - is sodium the sole culprit? 30 Dual Mycobacterium margeritense and Nocardia Infection of a CRT-D Pocket: Diagnostic and Therapeutic Challenges. 31 Enhancing Syphilis Screening in Asymptomatic Individuals within the Primary Care Setting. 31 Favism and Pernicious Anemia Converging in a Case of Severe Hemolytic Crisis. 32 Recurrent Chylothorax Secondary to Kaposi Sarcoma Infiltration of Thoracic Duct in AIDS Patient. 33 Financial Implications of Routine Homocysteine Level Testing for Venous Thromboembolism and Stroke: An Institutional Review. 33 Granulomatosis with Polyangiitis Masked as Chronic Otomastoiditis. 34 Hepatopulmonary syndrome (HPS) ought to be considered in patients with chronic liver disease and persistent hypoxia 35 Hidden in Plain Sight: A Decade-Long Undetected Pacemaker Lead Misplacement 35 Hyperinsulinemic Hypoglycemia, the Antithesis of Diabetes Mellitus 36 Infective Endocarditis: Relying on a Clinical Diagnosis
CONTENTS CONTINUED
65 When Low Suspicion Comes at a High Cost: Laryngeal Kaposi Sarcoma and the Case for Broader HIV Testing 65 From Antivirals to Acidosis, Unmasking a Rare case of Lactic Acidosis from Biktarvy POSTER PRESENTATIONS – STUDENTS 67 Effect of Dual CAR-NK Cell (anti-MCAM + anti- ROR1) Immunotherapy Against Osteosarcoma 67 Unraveling the Complexity of Fibrolamellar Carcinoma: An Unfortunate Case of Rare Liver Cancer 68 Treatment to Turmoil: Ibrutinib’s Impact on Cardiovascular outcomes in Lymphoplasmacytic Lymphoma 69 Low Sugar? Not So Sweet: A Case of Osmotic Demyelination Syndrome Secondary to Rapid Correction of Hyperglycemia 69 Investigation of Cytological Changes in Benign Thyroid Nodules Post-Radiofrequency Ablation 70 Exploring Neuropsychological Testing in Cardiovascular Research: Insights on Cognitive Assessment Practices 71 Inhibition of Sphingomyelinase 2 decreases cell proliferation and migration in aggressive prostate cancer cells 71 Torsade’s and Triggers: Navigating QTc Prolongation in HIV-Related Cryptococcal Infection 72 The great imitator: Neurosyphilis mimicking Giant Cell Arteritis 73 Assessing the Readability of Colon Cancer Information Generated by Large Language Models 73 Hungry for Help: The Need for Food Security Screening in North Louisiana’s Opioid-Using Population 74 Assessing the Effectiveness of Social Determinants of Health Screening 74 PICC-ing Up The Pieces: PICC Line Use in People
Without Immunosuppression 52 Stevens-Johnson Syndrome Secondary to Vancomycin and Ceftriaxone: A Case Report 52 Systemic Sequelae of Dental Infections: Are Brain Abscesses the Tip of the Iceberg? 53 The Gangs of Glomus Return: Recurrent Paragangliomas in Hereditary PGL-1 Syndrome with Hyperparathyroidis 54 The Many Heads of Hydralazine: A Rare Case of Hydralazine Induced Lupus Erythematosus and Hydralazine Induced p-ANCA Positive Bullous Hemorrhagic Sweet Syndrome 55 Top to Bottom: Atypical Guillain-Barre Presentation in a Patient with Cerebral Palsy 55 Toxic Shock Syndrome in a Case of Group A Streptococcal Pneumonia 56 Understanding Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted Diffusion Syndrome: An Opiate-Related Neurological Emergency 57 Unmasking the Silent Threat: A Case of Hypertrophic Cardiomyopathy Eluding Echocardiographic Detection 57 Unravelling Differentiation Syndrome 58 Unveiling the Spots: Acute Vision Loss and Positive Autoantibodies 58 Unveiling Varicella Zoster Meningitis: Stroke-Like Symptoms as Initial Presentation in an Immunocompetent Adult 59 Uterine Fibroids With IVC compression; A rare cause of Deep Vein Thrombosis 60 Visceral Kaposi Sarcoma Presenting as Oral Pain 60 When Prevention Provokes: Unexplained Pancreatitis in a PrEP User 61 When Transfusion Turns Toxic: A Case of Hyperhemolysis Syndrome in a Sickle Cell Patient 62 Abstract Winners ORAL PRESENTATIONS – STUDENTS 63 Beyond Traditional Risk Factors in Necrotizing Fasciitis Mortality - Analysis of 40,254 Cases Challenges Common Assumptions 63 When Anatomy Meets Pathology: The Role of May- Thurner Syndrome in Young Ischemic Stroke 64 Zieve’s Syndrome: A Zebra or an Underrecognized Hemolytic Anemia
Who Inject Drugs (PWID) with Infective Endocarditis: A Review of the Literature 75 Sustainability in Healthcare: Exploring Interest in Future Improvements 76 Olanzapine-associated Angioedema 77 Two ocular syphilis cases diagnosed within a year at a rural secondary care center
77 Catastrophic Atrial Septal Rupture Post-Mitral Valve Replacement in a Patient with Pulmonary Hypertension 78 Delays in Access to Care in a Case of Bilateral Quadriceps Tendon Rupture
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Each year residents from the nine Internal Medicine training programs in Louisiana are invited to submit abstracts for the Annual American College of Physicians (ACP) Meeting of the Louisiana Chapter. The content of these abstracts includes clinical case vignettes or research activities. The abstracts have all identifying features removed (i.e., names, institutional affiliations, etc.) before being sent to physician judges. This year a total of 165 abstracts were submitted for the meeting. Each judge scores each abstract independently and then the scores from all judges are averaged and ranked. This year we are excited to be able to publish the most highly ranked resident (14) abstracts presented at this year’s competition that were selected for oral presentations. An additional selection of resident (72) abstracts presented as posters were selected by judges for publication. All abstracts were presented at the Associates Meeting held at The Lions Eye Center on the LSU Health Sciences Center campus in New Orleans on January 31, 2025. We would like to thank the resident council for helping score the abstracts selected for presentation: Chikwudi Anago-Amanze, Ochsner Medical Center; Michael Millet, LSU New Orleans, Amit Rajkarnikar, LSU Lafayette; Connor Bennett, LSU Baton Rouge; Austin Falloon, Tulane University; Maitri Acharekar, Baton Rouge General; Arpita Pawa and Keval Thakkar, Willis Knighton. We would like to thank the Journal of the Louisiana State Medical Society and appreciate its efforts to publicize the hard work of these trainees.
Shane Sanne, DO, FACP Co-Chair, Louisiana Associates Liaison Committee Miranda Mitchell, MD Co-Chair, Louisiana Associates Liaison Committee Dexter Matrana, DO Co-Chair, Louisiana Associates Liaison Committee Angela McLean, MD, FACP Governor, Louisiana Chapter ACP
ABSTRACT WINNERS
ORAL PRESENTATIONS – RESIDENTS SESSION 1 1st place - Pickering Syndrome Ross Dies , Mandie DiMarco, Jack Hebert, William Gibson, Domonique Smith, Brian Coe, Arash Ataei, Seth Vignes; Louisiana State University, New Orleans, LA.
POSTER PRESENTATIONS – RESIDENTS 1st place - Hepatopulmonary syndrome (HPS) ought to be considered in patients with chronic liver disease and persistent hypoxia
Amit Rajkarnikar , Jonathan B. Vignes; Louisiana State University, Lafayette, LA.
SESSION 2 1st place - Paradoxical embolism to the coronary arteries: an uncommon cause of acute Myocardial Infarction
2nd place - Leptospirosis: An Uncommon Cause of Fever and Transaminitis in the Continental United States Allen Byl , Hope Oddo Moise, Danielle Gilbert, Michael Olejniczak, Ashley Misky, Tom Fox, Alexa Lapointe, Michael Modica, Michelle Blyth; Louisiana State University, New Orleans, LA. 3rd place - Recurrent Chylothorax Secondary to Kaposi Sarcoma Infiltration of Thoracic Duct in AIDS Patient Gurtaj Mahil , Brandon Dang, Tamara Zaza, Victoria Lulich, Zachary Chandler, Kyle Happel, Shane Guillory; Louisiana State University, New Orleans, LA.
Swesha Shrestha, Shekhar Gurung, Nisheem Pokharel, Thomas R Smith; St Francis Medical Center, Monroe, LA.
MYSTERY CASE PRESENTATIONS – RESIDENTS 1st place - Rare vascular anomaly causing nonspecific chest pain and worsening dysphagia Neha Bapatla , Jacques F. Ancelet, Stephen C. Lim; Tulane University, New Orleans, LA.
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ORAL PRESENTATIONS – RESIDENTS SESSION 1
NEUROENDOCRINE TUMORS: ENDOCRINE INSIGHTS IN A CASE OF CHRONIC DIARRHEA Warda Siddiqui, Stephan Francis, Jason Taylor; Leonard J Chabert Medical Center, Houma, LA.
Introduction: Neuroendocrine neoplasms have an estimated global incidence of 6 out of 100,000 and a prevalence of 35 out of 100,000. The clinical trajectory of patients with well-differentiated gastroenteropancreatic neuroendocrine tumors (NET) varies greatly, with some remaining asymptomatic for years while others experience symptoms due to tumor size or hormone overproduction. Case: A 45-year-old male with GERD and tobacco dependence presented with chronic diarrhea for over two years, alongside sudden nausea, vomiting, diaphoresis, and fatigue over the past two weeks. He was unable to tolerate oral intake, vomiting 8-10 times prior to admission, and reported intermittent, stabbing, non-radiating periumbilical pain lasting over a year. Admission labs were significant for leukocytosis with a left shift, creatinine 1.4 μmol/L (baseline 1 μmol/L), lactate 4 mmol/L, ESR and CRP within normal limits. He had no family history of colon cancer and denied weight loss or constitutional symptoms. He was evaluated by his primary care physician and a gastroenterologist, and a outpatient CT-abdomen was significant for a soft-tissue mass behind the second portion of the duodenum. He underwent an esophagogastroduodenoscopy (EGD) and colonoscopy, revealing mild gastritis and
diverticulosis, and was diagnosed with irritable bowel syndrome subtype-D, for which he was prescribed loperamide and bentyl without significant relief. The patient received intravenous fluids, ciproloxicin/metronidazole, and odanesteron, and had negative stool studies. The leukocytosis and acute renal failure resolved by the next day, and he was tolerating a diet. He was discharged with a gastroenterology (GI) referral but was readmitted multiple times that month for similar symptoms and lab results. During his third admission, a repeat CT abdomen showed an enlarging soft-tissue lesion, with elevated chromogranin and HIAA levels. He underwent another EGD with ultrasound and a biopsy of peri duodenal lymph nodes confirmed a well-differentiated NET. He is now under the care of surgical oncology with a planned whipple procedure. Discussion: Clinicians should expand their differential for patients with recurrent GI symptoms, as NET treatment options differ markedly from those for other common conditions. While most NETs grow slowly, some can be aggressive, and certain tumors may secrete peptide hormones or biogenic amines, leading to significant hormonal syndromes. Early diagnosis is essential to reduce morbidity and mortality.
MYSTERY OF MADNESS: UNRAVELING A RARE CAUSE OF COMMON PSYCHIATRIC SYMPTOMS Saisruthi Regalla, Raja Saravanan, Ethan Greenblatt; Baton Rouge General Hospital, Baton Rouge, LA.
Introduction: Anti-N-methyl D-aspartate receptor (Anti-NMDAR) encephalitis is a type of autoimmune encephalitis that occurs due to the presence of IgG antibodies against the NR1 subunit of NMDA receptors in the central nervous system. The exact etiology of antibody production is unknown; however, it is stated that in some patients, antibody production is triggered by associated
ovarian teratoma, or prior herpes simplex virus encephalitis. It is a rare disease, affecting one out of 1.5 million people per year. Young adult females between 25-35 years are most affected. Case: A 20-year-old female was admitted to the psychiatry unit for evaluation of acute onset of bizarre behavior and persecutory delusions,
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Discussion: Schizophrenia-like psychiatric symptoms, mood disturbances and behavioral changes occur in 80% of cases in anti-NMDAR encephalitis. The absence of classic prodromal symptoms such as fatigue or flu-like illness with predominant early psychiatric manifestation, as in this patient, makes the diagnosis challenging. These symptoms can easily be mistaken for primary psychiatric disorders, which can delay treatment. Progressive neurologic decline and death can occur without treatment and hence early recognition and evaluation is crucial for timely management. Patients with anti-NMDA receptor encephalitis continue to have residual cognitive, behavioral and psychiatric alterations that can last more than a year. Relapses can occur in 15-24% of patients, sometimes after several years.
initially managed with Olanzapine, Quetiapine and Hydroxyzine. She developed seizure-like activity, raising suspicions for extrapyramidal symptoms unresponsive to benztropine, and subsequently diagnosed as refractory status epilepticus requiring intubation and sedation. A CT of the head revealed no abnormalities. Electroencephalogram showed diffuse slowing with delta waves consistent with severe encephalopathy. Cerebrospinal fluid had lymphocytic pleocytosis with negative microbial cultures. Further work-up showed elevated inflammatory markers and positive ANA. This prompted further workup with an autoimmune encephalitis panel, which came back positive for anti-NMDA receptor antibodies. A 5-day course of high-dose methylprednisolone and intravenous immunoglobulin showed mild
improvement in her mental and functional status. Malignancy workup was negative.
A RARE PRESENTATION OF HEREDITARY CHOLESTATIC LIVER DISEASE IN A YOUNG ADULT PATIENT Vy Luong, Ahmad Anbar, Melanie Bienvenu; Louisiana State University, Lafayette, LA
Introduction: Progressive familial intrahepatic cholestasis (PFIC) is characterized by defective bile acid secretion leading to liver dysfunction, usually present during infancy or childhood, and is associated with growth failure and progressive liver disease. PFIC type I/II is associated with mutations in the ATP8B1/ABCB11 genes. Diagnosis of these conditions relies on genetic testing, liver biopsy, and serologic evaluations. Treatment strategies focus on ursodeoxycholic acid being first-line treatment, followed by bile acid sequestrants or ileal bile acid transport inhibitors. Surgical options, including liver transplantation or biliary diversion procedures, are reserved for severe cases or those unresponsive to medical management. Case: A 24-year-old female with a history of morbid obesity and polycystic ovarian syndrome and no known family history of cholestatic liver disease, presented with diffuse jaundice and itching for two days. The patient noted no recent or current usage of oral contraceptives. Laboratory findings show elevated total bilirubin and alkaline phosphatase levels, but normal transaminases. A serologic work-up for autoimmune hepatitis, primary biliary cholangitis, hereditary hemochromatosis, Wilson’s disease, and drug-induced liver disease
was negative. Genetic testing revealed pathogenic variants in the ATP8B1 gene associated with various forms of intrahepatic cholestasis. A liver biopsy showed severe lobular cholestasis, biliary injury, macrosteatosis, and mild fibrosis. She was diagnosed with cholestatic liver disease, possibly familial intrahepatic cholestasis. Treatment was initiated with weight-based ursodiol and cholestyramine, leading to clinical improvement of symptoms. Discussion: This case highlights a rare and acute onset presentation of cholestatic liver disease in a young adult patient, who presented with very mild clinical symptoms and no known family history of cholestatic liver disease. Mutations in the genes responsible for cholestatic disorders usually generate chronic inflammatory states associated with the risks of developing hepatobiliary cancers but can also be accountable for clinically mild phenotypes. Despite the challenges in diagnosis and management, a multidisciplinary approach involving hepatologists, geneticists, and dietitians is essential for optimal care.
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PICKERING SYNDROME. Ross Dies, Kristen Williams, Mandie DiMarco, Jack Hebert, William Gibson, Domonique Smith, Brian Coe, Arash Ataei, Seth Vignes, Louisiana State University, New Orleans, LA.
Introduction: Bilateral renal artery stenosis (BRAS) is often secondary to atherosclerosis in patients over 45 years of age and fibromuscular dysplasia in women under 50 years of age. A strong predictor for renovascular disease is rapidly developing severe hypertension. Pickering Syndrome (PS) is diagnosed in the setting of BRAS with flash pulmonary edema from rapid arterial pressure rise leading to left ventricular failure. The prevalence of PS is difficult to estimate, but renal artery stenosis (RAS) has a prevalence of less than 1% for patients with mild hypertension and up to 40% for more severe cases. Less than half of these patients have BRAS. Treatment options include medical therapy, renal stenting, or surgical revascularization. Case: A 77-year-old woman with chronic obstructive pulmonary disease and left subclavian artery occlusion presented with acute dyspnea and bilateral lower extremity edema. She was afebrile, non-tachycardic, tachypneic to 38 bpm, blood pressure of 215/96 mmHg (right arm), and had an oxygen saturation of 77% on room air. Notably, her left arm blood pressure was lower though inaccurate due to subclavian occlusion. A point- of-care ultrasound demonstrated elevated jugular venous pressure, adequate cardiac contractility, and
fluid in the lung fields. Initial labs demonstrated elevated B-type Natriuretic Peptide and minimally elevated troponin. She was placed on continuous positive airway pressure with symptomatic improvement. A computed tomography angiography of kidneys revealed near-total occlusion of bilateral renal arteries. She improved over a few days with diuresis and blood pressure control and discharged with a plan for renal artery stenting. Discussion: This case demonstrates the importance of considering renal pathology when determining the cause of recurrent flash pulmonary edema. PS should be considered in patients with resistant hypertension manifesting recurrent pulmonary edema with preserved left ventricular function. The CORAL and ASTRIAL trials demonstrated that medical therapy was not inferior to renal artery stenting. Several studies have shown that up to 75% of patients who underwent revascularization did not have further episodes of pulmonary edema. Notably, the ACC/AHA guidelines demonstrate a class I indication for stenting in patients with significant RAS and recurrent unexplained pulmonary edema. Ultimately, a multidisciplinary team should determine the most appropriate treatment plan for patients with significant RAS.
SYSTEMIC LUPUS ERYTHEMATOSUS PRESENTING WITH SEVERE MIXED AUTO-IMMUNE HEMOLYTIC ANEMIA Deekshitha Manney, Jorge Martinez Bencosme, Nisheem Pokharel; St Francis Medical Center, Monroe, LA.
Introduction: Autoimmune hemolytic anemia (AIHA) is a rare and acquired autoantibody mediated destruction of red blood cells (RBCs). AIHA can be categorized as warm, cold and mixed based on the temperature dependent activity of autoantibodies. Warm AIHA is mediated by IgG while cold AIHA is mediated by complement component c3d (cold agglutinins). Mixed AIHA has features of both and is a very rare presentation, usually developing later on in the disease process of autoimmune conditions such as systemic lupus erythematosus (SLE).
one day. On examination, she was tachycardic, pale and had axillary lymphadenopathy. Initial laboratory investigations revealed low hemoglobin and hematocrit, with 28.24% reticulocytes (N<2.5%). Further labs revealed an elevated total bilirubin, high LDH and low haptoglobin necessitating a hemolytic work up. Her antibody screen came back positive for IgG and C3d, and patient’s blood agglutinated at room temperature suggesting the presence of both warm and cold hemolysis. Concurrent autoimmune work up showed positive ANA with positive anti-smith antibodies and low complement levels meeting the clinical and immunological criteria for the diagnosis of SLE. Lymph node biopsy ruled 8
Case: A 38-year-old female with no past medical history presented with dyspnea and dizziness of
out malignancy. She was subsequently diagnosed with mixed AIHA in setting of SLE, for which she was transfused with packed red blood cells and started on high dose steroids for treatment. The patient reported clinical improvement, leading to discharge from the hospital on oral prednisone. Discussion: SLE is a chronic autoimmune, multisystem connective tissue disease of unknown etiology with heterogenous clinical picture. AIHA
is seen in 10% of patients with SLE and very rarely precedes the development of SLE. Mixed AIHA is often more severe with a presenting hemoglobin of less than 6 mg/dL and often requires multiple lines of treatment. The presence of hemolysis markers in the setting of known SLE should be followed by a Coombs test. Likewise, any patient presenting with AIHA must be screened for SLE as presence of AIHA in general is correlated with severe SLE.
BAD BLOOD: A RARE CASE OF PARANEOPLASTIC ACQUIRED HEMOPHILIA A (AHA) IN AN ELDERLY INDIVIDUAL Kashish Shah, Het Patel, Anil Veluvolu; Willis-Knighton Medical Center, Shreveport, LA.
Introduction: Acquired Hemophilia A (AHA) is a rare bleeding disorder with an incidence of about 1.5 per million per year. While 50% of the cases are idiopathic, around 10% of the cases are associated with an underlying malignancy. Case: A 65-year-old male with a history of head and neck squamous cell carcinoma, non-small cell lung carcinoma (NSCLC) and renal cell carcinoma (diagnosed six and four months before presentation, respectively) was being treated with chemoradiation, presented to an outside facility with fatigue, weakness, and hypotension. Examination revealed swelling and tenderness over his bilateral arms, left buttock, and right thigh. The hemoglobin was 3 gm/dl and fecal occult blood testing was positive. He had no history of coagulopathy and was not on any anticoagulation. There was no evidence of active bleeding. Ultrasound of the extremities showed intramuscular hematomas in the right triceps, right quadriceps, and left gluteal musculature. Three units of packed red blood cells were transfused and the patient was transferred to our facility for further evaluation and management. Coagulation studies showed isolated elevation of activated partial thrombplastin time (aPTT), and
platelets were within normal range. Administration of aminocaproic acid and four units of fresh frozen plasma didn’t lead to any improvement in the aPTT. Suspecting AHA, empirical methylprednisolone was started, and recombinant factor VIIa and Humate-P were administered. Factor VIII activity levels were <1% and not corrected by 1:1 mixing study. Dilute Russell’s Viper Venom Time (DRVVT) test for lupus anticoagulant was negative. Factor VIII inhibitor levels were elevated, confirming the diagnosis. Rituximab was added to increase immunosuppression. Following a serial improvement in aPTT with minimal improvement in Factor VIII inhibitor levels and Factor VIII activity, the patient was discharged after three weeks of treatment with further plans to continue the remaining treatment as well as NSCLC chemoradiation on an outpatient basis. Discussion: Early diagnosis and prompt treatment plays a fundamental role in determining patient outcomes in AHA. Optimum management includes replacement of factors in the acute setting and immunosuppression with high dose steroids. Rituximab can be added in severe or refractory cases. Treatment of the underlying condition, malignancy in our case, remains imperative in achieving remission.
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ORAL PRESENTATIONS – RESIDENTS SESSION 2
SARCOIDOSIS AND IGA NEPHROPATHY: AN EMERGING ASSOCIATION. Sravya Sri Kuchipudi, Suzanne Cooper, MD, Supraja Yeturi, MD; Louisiana State University, Lafayette, LA.
Introduction: Sarcoidosis is a chronic inflammatory disease characterized by non-caseating granulomatous inflammation, commonly presenting with bilateral hilar lymphadenopathy, pulmonary infiltrates, skin lesions, and ocular lesions. Although glomerular diseases are a rare association, the link between sarcoidosis and IgA nephropathy is increasingly recognized. Several studies suggest that immune dysregulation leads to IgA deposition in the glomerular mesangium, with elevated IgA levels observed in both conditions. Cytokine production may play a critical role in the glycosylation of systemic IgA, contributing to IgA nephropathy. Other research indicates a strong association through HLA linkage. Despite these findings, the relationship between sarcoidosis and IgA nephropathy remains poorly understood and controversial. Case: We present a 35-year-old African American female who presented to the emergency room with complaints of chronic shortness of breath worsening over the last two weeks as well as a new-onset rash over her buttocks first appearing approximately three months prior. She was hypoxic on room air at presentation. Lab work showed elevated inflammatory markers but was otherwise unremarkable. CTA revealed extensive bilateral infiltrates and mediastinal lymphadenopathy.
The patient was admitted to the hospital and initial workup revealed a positive ANA of 1:160 and significant proteinuria on urinalysis. Extensive infectious workup returned unremarkable. Multiple subspecialities were consulted including rheumatology, infectious disease, nephrology, and pulmonology. EBUS was attempted but the patient was unable to tolerate the procedure. A skin biopsy was then performed revealing noncaseating granulomas and ACE level was found to be elevated, confirming sarcoidosis. She was discharged on a steroid taper with instructions to continue outpatient follow-up. Later on, kidney biopsy was done secondary to persistent proteinuria revealing immunofluorescence staining consistent with IgA nephropathy. She was initiated Methotrexate for sarcoidosis and budesonide for IgA nephropathy. Discussion: There is growing evidence suggesting a connection between sarcoidosis and IgA nephropathy although it remains controversial and poorly understood. Similar environmental, genetic, and immunological factors might be responsible for the pathogenesis of both disease states which might be contributing to their association. Further research is needed to fully understand and explain this causal relationship.
AN ELECTRICAL STORM OF THE HEART. Jason Onwenu, Sepehr Sadeghi, Brandon Dang, Trent Davidge, Mehnaz Rahman; Louisiana State University, New Orleans, LA.
Introduction: Ventricular tachycardia (VT) storm is defined as three or more sustained episodes of VT or fibrillation within 24 hours without a reversible cause. It occurs in about 10% of implantable cardiaoverter defibrillator (ICD) patients and 7-11% of left ventricular assist device (LVAD) patients. Risk factors include lower ejection fraction, ischemic cardiomyopathy, and structural heart disease.
Case: A 75-year-old woman with hypertension, coronary artery disease, heart failure with reduced ejection fraction (HFrEF) of 30-35%, a dual-chamber ICD, and left ventricular aneurysm presented with intermittent palpitations and chest discomfort. She reported two episodes of “ICD firing” earlier that day. She denied chest pain, shortness of breath, dyspnea on exertion, lower extremity edema, orthopnea, or 10
paroxysmal nocturnal dyspnea. Initial vitals showed an afebrile, hemodynamically stable patient. Labs revealed mild hypokalemia, hypomagnesemia, elevated high-sensitivity troponin of 12 ng/mL, and a BNP of 235 ng/L (baseline). Cardiac monitoring and an electrocardiogram showed monomorphic VT with heart rates in the 180-210 bpm range, requiring anti-tachycardia pacing (ATP) and three episodes of shock at 35 joules. She was started on amiodarone bolus and infusion, metoprolol tartrate, and dual antiplatelet therapy. Myocardial viability study revealed no viable myocardium in the left circumflex (LCx) territory. An echocardiogram showed a decreased EF of 20-25%, apical left ventricular aneurysm, and reduced wall motion. A Electrophysiology consult attributed the VT to ischemia. She underwent left heart catheterization, revealing complete total occlusion of the proximal
left anterior descending (LAD) artery with established collaterals and 70% stenosis of the ostial lateral LCx. Successful placement of a drug-eluting stent from the left main to the LCx prevented further VT episodes. She was discharged on dual antiplatelet
therapy, amiodarone taper, and restarted on guideline-directed medical therapy (GDMT).
Discussion: This case illustrates the multifaceted approach to treating a VT storm. Ablation is the first-line therapy, but LCx revascularization was prioritized to prevent scarring that could worsen the condition. While revascularization does not directly treat the storm, it reduces mortality. Managing the storm involved initiating antiarrhythmic therapy, revascularization, and optimizing GDMT to minimize mortality, rehospitalization, and adverse outcomes.
PARADOXICAL EMBOLISM TO THE CORONARY ARTERIES: AN UNCOMMON CAUSE OF ACUTE MYOCARDIAL INFARCTION Swesha Shrestha, Shekhar Gurung MD, Nisheem Pokharel MD, Thomas R Smith MD; St Francis Medical Center, Monroe, LA.
Introduction: Coronary embolism accounts for approximately 3% of cases of myocardial infarction with no coronary atherosclerosis (MINOCA), often linked to conditions like atrial fibrillation and infective endocarditis. Even less commonly, this can happen via paradoxical embolism in the setting of a patent foramen ovale (PFO). The coronary artery anatomy, with its right-angle departure from the aortic root and partial covering by aortic valve cusps, and its size disparity from the aorta with diastolic filling make this condition rare. Case: A 48-year-old male with no significant medical history presented with unrelieved dull aching central chest pain. He had a BMI of 24 and did not smoke or drink alcohol. Workup revealed a significantly elevated troponin I level of 4.53 ng/mL, up trending to 13.56 ng/mL. An EKG demonstrated sinus bradycardia without ST-segment changes. Emergent coronary angiography revealed no significant atherosclerotic disease. However, there was a notable thrombus in the distal segment of a small-caliber diagonal branch with faint distal flow. The vessel was deemed too small and distal to be intervened on or evaluated with an intravascular ultrasound.
Given the concern for a cardioembolic event, heparin was initiated. A transthoracic echocardiogram demonstrated a structurally normal heart with a normal ejection fraction. A transesophageal echocardiogram with bubble study confirmed the presence of a PFO. Symptoms subsided in less than 24 hours, and he was discharged in stable condition on apixaban, clopidogrel, and atorvastatin with plans for PFO closure and a loop recorder placement. No arrhythmia was detected during his hospital stay. Discussion: While paradoxical coronary embolism via PFO remains a rare cause of myocardial ischemia, it must be considered in patients without atherosclerosis or other traditional cardiovascular risk factors. It is important to understand the etiology as the management of embolic myocardial
ischemia requires additional considerations to prevent recurrence and improve patient
outcomes. Management involves a combination of anticoagulation and antiplatelet therapy to prevent further thromboembolic events, along with monitoring for occult arrhythmia. Consideration of PFO closure is also warranted, and decisions are individualized based on the patient’s risk profile. 11
THE UNEXPECTED VILLAIN: A CASE OF ACUTE EPIPLOIC APPENDAGITIS IN A YOUNG MALE WITH ACUTE ABDOMEN Edna Sarpong, Vaishnavi Singh, Het Patel, Anand Desai; Willis-Knighton Medical Center, Shreveport, LA.
Introduction: Acute epiploic appendagitis (AEA) is a rare, self-limiting inflammatory condition of the epiploic appendages, small fat-filled outpouchings along the colon. While often overlooked as a differential diagnosis, AEA can mimic more common causes of acute abdominal pain, such as appendicitis and diverticulitis. Typically presenting with localized pain and without systemic symptoms, AEA is diagnosed primarily through imaging, with CT scans showing fat stranding around the affected appendage. Case: A 21-year-old male presented with a three- day history of abdominal pain localized to the left iliac fossa. He reported the pain exacerbated with movements such as coughing, laughing and urination. He rated it at 4/10 at its worst and 2/10 at its best. He denied having nausea, vomiting, diarrhea, constipation, fever, and chills. His physical examination and laboratory findings were unremarkable. Initial CT imaging revealed AEA of the sigmoid colon. Conservative management was initiated with intravenous fluids, analgesics, and antibiotics (ciprofloxacin
and metronidazole). However, his pain worsened over the next two days, spreading to the right iliac fossa, though he remained afebrile and without additional symptoms. A repeat CT scan showed no progression of AEA but given his increasing symptoms and the development of rebound tenderness, General Surgery was consulted. Patient underwent a diagnostic laparoscopy which revealed an inflamed epiploic appendage of the sigmoid colon adherent to the anterior abdominal wall, which was subsequently resected. His recovery was uneventful, and he was discharged on the fourth day. Discussion: The exact incidence of epiploic appendagitis is unknown, but it is reported in 2% to 7% of patients initially suspected of acute diverticulitis and in 0.3% to 1% of those suspected of acute appendicitis. Our case reflects the typical presentation of AEA in young males with acute left abdominal pain. Clinicians must consider AEA as a differential diagnosis for acute abdominal pain. Timely recognition and appropriate intervention can prevent complications and reduce financial burdens.
EXPLORING METASTATIC PATHWAYS: NEUROENDOCRINE CARCINOMA OF THE LUNG WITH LIVER AND ADRENAL GLAND INVOLVEMENT.
Erica Jones, Jacob Cunningham, Archa Rajesh, Sri Pranvi Boyapati, Karen Curry; Louisiana State University Health Sciences Center at Ochsner University Hospital & Clinics, Department of Internal Medicine, Lafayette, LA.
Introduction: Neuroendocrine tumors (NETs) are composed of a unique class of neoplasms derived from endocrine and nervous systems. The subtypes represent a wide range of clinical presentations, from incidental findings to devastating metastatic disease. Neuroendocrine carcinomas (NECs) are poorly differentiated high- grade NETs, the most aggressive subtype. Case: A 61-year-old male with a history of tobacco use presented with abdominal pain, nausea, dyspnea, and a 9-month history of unexplained weight loss, after a recent diagnosis of carcinoma of unknown primary with liver metastases three weeks prior. The patient was referred to Surgical Oncology, and initial
tests showed marked elevation of CEA, CA 125, and CA 19-9. A CT scan revealed hepatomegaly, hepatic lesions, bilateral adrenal masses, and enlarged lymph nodes. On presentation, he was tachycardic and hypoxic. A CT chest angiogram ruled out pulmonary embolism but showed a left hilar mass obstructing the left upper lobe bronchus, causing complete collapse. He stabilized with analgesics and was discharged with an appointment for a liver biopsy two days later. One week later, he was admitted with acute pancreatitis. Oncology reviewed the liver biopsy, which had insufficient cellularity, but suggested extensive stage small cell lung cancer versus large cell neuroendocrine carcinoma. A repeat biopsy was recommended prior to initiating 12
chemotherapy which was complicated by suspected hemoperitoneum and rapid decline leading to intubation. Pathology confirmed high grade NEC with immunohistochemical stains positive for TTF-1, chromogranin, synaptophysin, and CD56, with near 100% KI-67 nuclear positivity. The patient quickly progressed to multi-organ system failure and expired shortly after transition to comfort focused care.
preceded the patient’s rapid clinical decline, it is crucial to recognize the morbidity related to the primary NEC and metastases. One such example is the obstructing lung mass resulting in complete collapse of the left upper lobe. This may have contributed to the patient’s respiratory decline leading to intubation and could further complicate weaning of mechanical ventilation. As such, early treatment with chemotherapy can potentially reduce risks and improve outcomes.
Discussion: While a procedural complication
13
MYSTERY CASE PRESENTATIONS – RESIDENTS
PARANEOPLASTIC ANTI-NMDAR ENCEPHALITIS: MYSTERY WITH AN OVARIAN TERATOMA TWIST Asad Mussarat, Catherine Loehr, Michelle Livitz, Will Gibson, Allison Pinner; LSU Health Science Center, Department of Internal Medicine, New Orleans, LA.
Introduction: Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a potentially lethal autoimmune encephalitis in young adults. It typically begins with a viral-like prodrome, followed by neuropsychiatric symptoms and is diagnosed by detecting autoantibodies in cerebrospinal fluid (CSF). Since 2007, research has linked anti-NMDAR encephalitis with ovarian teratomas as a paraneoplastic syndrome. We present a case of a young woman whose encephalitis course takes an unexpected turn. Case: A 25-year-old woman without a past medical history developed headaches, fevers, vomiting, and a seizure after five days. Her partner witnessed another seizure involving jerking movements. Despite normal physical exams, a negative electroencephalogram, and a brain magnetic resonance revealed bilateral temporal edema. CSF analysis showed increased red blood cells and lymphocytic pleocytosis, raising suspicion of herpes simplex virus (HSV) encephalitis. She initially improved on acyclovir and steroids but became encephalopathic a week later, with emotional outbursts. Autonomic instability led to an intensive care unit admission, as she needed to be intubated. HSV tests were negative, but a
computed tomography scan of her abdomen and pelvis revealed a right ovarian dermoid cyst, which was confirmed surgically as an ovarian teratoma. CSF analysis detected anti-NMDA receptor antibodies, confirming anti-NMDAR encephalitis. After treatment with IVIG, steroids, cyclophosphamide, and plasmapheresis, she improved but required long- term rehabilitation, remaining far from her baseline. Discussion: Research indicates a significant link between anti-NMDAR encephalitis and ovarian teratomas. It is believed that neuronal tissue in the teratoma triggers an immune response, producing autoantibodies that mistakenly target NMDA receptors in the brain. This paraneoplastic syndrome results in autoimmune destruction and severe neuropsychiatric symptoms, drastically affecting quality of life. Despite its rare incidence, autoimmune encephalitis should be considered in young encephalopathic patients, particularly women. Early surgical resection of ovarian tumors is crucial in anti-NMDAR encephalitis, as prolonged autoimmune activity worsens its prognosis. Recognizing this paraneoplastic association enables more effective interventions and improved outcomes.
KOMMERELL DIVERTICULUM: A RARE VASCULAR ANOMALY CAUSING NONSPECIFIC CHEST PAIN Neha Bapatla, Jacques F. Ancelet, Stephen C. Lim; Tulane University, New Orleans, LA.
Introduction: Chest pain is one of the most common symptoms for which individuals seek evaluation and treatment. While cardiopulmonary and gastrointestinal causes of chest pain tend to follow familiar patterns of presentation, vascular etiologies are often missed unless overtly symptomatic and thus present a challenge to diagnosticians. Case: 28-year-old male presented with chest pain and new dysphagia. He reported a sharp substernal chest pain radiating intermittently to the bilateral
upper and lower extremities. Pain was rated at a 10/10, present at rest, and exacerbated when laying down. His chest pain had been recurring over the past decade. Notably, the patient reported new dysphagia over the past year. He experienced dysphagia primarily to solids although intermittently experienced a globus sensation with liquids as well. He endorsed subjective weight loss due to an inability to eat or drink with associated diffuse abdominal discomfort--although he was seen eating a sandwich in the emergency room without difficulty. The 14
Discussion: Chest pain is the most common complaint in the emergency department and frequently follows recognizable illness scripts; however, nonspecific chest pain in the setting of an unremarkable initial evaluation oftentimes does not initiate further investigation and can be overlooked as malingering. While cardiac and gastrointestinal causes of chest pain follow a specific pattern, it is imperative to consider vascular etiologies in the setting of concomitant chest pain and dysphagia. A Kommerell diverticulum is a proximal aneurysmal dilatation of an aberrant subclavian artery and often accompanied by other congenital abnormalities of the aortic arch. The specific combination of a Kommerell diverticulum with right-sided aortic arch and aberrant left subclavian artery is exceptionally rare. It is usually asymptomatic and found on incidental imaging; however, presentations may include chest pain, dysphagia, syncope, and reactive airway disease. This case highlights the diagnostic challenge of identifying vascular anomalies as a cause of chest pain in an otherwise young, healthy adult while concomitantly challenging our implicit bias in an individual whose behaviors align with malingering.
patient also noted a history of unwitnessed syncopal episodes, with a recent episode precipitated during a bowel movement. On chart review, the patient had a pervasive history over the prior decade of routine emergency department visits in multiple states for nonspecific chest pain for which basic evaluation was consistently unrevealing. Pertinent findings his on physical examination included distractible pain to light palpation of the anterior chest wall and diffusely over the abdomen and mild expiratory wheezes auscultated in the upper left lung field. Labs were grossly unremarkable. A chest x-ray revealed abnormal thickening of the tracheo-esophageal interface, concerning for a posterior mediastinal abnormality. A CT of the chest with contrast showed a right-sided aortic arch with aberrant left subclavian artery and associated 2.4 cm Kommerell diverticulum. A CT esophagram further delineated a bulbous enlargement of the proximal subclavian artery posterior to the esophagus with evidence of compression by the left subclavian artery on the adjacent esophagus causing displacement anteriorly. Patient was referred for outpatient evaluation with Vascular Surgery but ultimately lost to follow up.
15
POSTER PRESENTATIONS – RESIDENTS
TURNING THE TIDE: THE IMPACT OF EARLY INTERVENTION WITH STEROIDS ON PATIENT OUTCOMES IN NON-COVID PNEUMONIA, INSIGHTS FROM A CASE. Sravya Sri Kuchipudi, Mekha Mathew, Shaun Walker; Louisiana State University, Lafayette, LA.
Introduction: Pneumonia is a leading cause of morbidity and mortality, often complicated by acute respiratory distress syndrome (ARDS). Early corticosteroid administration improves outcomes: reducing hospital stays, need for mechanical ventilation, mortality. Case: A 47-year-old male with a history of type 2 diabetes mellitus and a recent hospital admission for right heel osteomyelitis who was on intravenous antibiotics, initially presented with gastroenteritis symptoms, productive cough, and shortness of breath. On initial assessment, the patient was afebrile, tachycardic, with a blood pressure of 172/92 mmHg, and normal saturations. Chest X-ray showed bilateral consolidations. Later, his oxygen saturation rapidly declined to 72% on room air, showing minimal improvement even with supplemental oxygen. An arterial blood gass revealed severe hypoxia, PaO2/ FiO2 ratio of 112. A CT angiogram of the chest showed a multifocal pneumonia, without a pulmonary embolism. Given his rapidly deteriorating condition, we were concerned about ARDS. On day two, we initiated hydrocortisone 50 mg every six hours upon
confirmation from pulmonology and transferred him to the intensive care unit on Vapotherm. Additionally, he received broad spectrum antibiotics for both pneumonia and osteomyelitis, which were later de-escalated based on subsequent workup. By day four, he successfully tolerated an oxygen wean and maintained stability while tapering off steroids. Chest physiotherapy was done. Repeat Chest Xray on the day of discharge showed improvement. Discussion: In this case, aggressive hydrocortisone regimen is used which is contrast to typical practices where corticosteroids are often underutilized due to concerns about side effects and unclear dosing/timing. COVID-19 reinforced the efficacy of corticosteroids in respiratory distress, especially in ARDS but data on their use in non-COVID pneumonia is limited. There is some recent evidence which showed that initiating steroids within 48 hours in severe pneumonia has shown improved outcomes. Further research is essential to establish guidelines about using steroids in treatment protocols and improve outcomes in severe pneumonia.
TEETH OF TRUTH: A SJOGREN’S JOURNEY. Edison Tenezaca, Liana Lekishvili MD; Leonard J Chabert Medical Center, Houma, LA.
Introduction: Sjogren’s syndrome (SjS) is an autoimmune disease with the pathologic hallmark of lymphocytic infiltration of exocrine glands. Classic presentation of SjS is a middle-aged woman with primary features of keratoconjunctivitis and xerostomia, as the immune system targets the salivary and the lacrimal glands. Patients also may experience organ-specific symptoms, as well as general symptoms including fatigue, depression, and chronic musculoskeletal pain. Interstitial lung disease (ILD) is classically described as a late complication of primary SjS with ages ranging from 55-61 years.
and GERD presented for worsening shortness of breath which had limited her ability to walk up the stairs and carry her child. The patient became hypoxic and tachycardia while ambulating. With exertion it was noted that her SpO2 decreased to the mid 80’s. A CT of the chest showed mosaic attenuation pattern in lungs bilaterally possibly representing ground glass consolidation. She was empirically started on pneumonia treatment with levofloxacin. COVID and influenza testing was negative. On routine questioning, the patient revealed she had dentures for the past two years, which is very common in her family due to “bad teeth.” In addition, she does tend to get dry eyes on 16
Case: A 24-year-old female with asthma, anxiety
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