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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