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
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