AN AIRWAY WATCH: A CASE OF LARYNGEAL KAPOSI’S SARCOMA. Michelle Livitz, Tara Bates, Anna Chataginer, Yseult McNeely-Smith, Amita Krishnan; Louisiana State University, New Orleans.
Introduction: Kaposi Sarcoma (KS) is a soft tissue, vascular tumor that presents as a violaceous plaque on skin or mucocutaneous surfaces that are due to the HHV-8 virus, most often identified in immunocompromised populations. These lesions can ulcerate or invade into nearby structures and have a predilection for the pulmonary and gastrointestinal systems. These are high-risk vascular lesions that can cause life-threatening bleeding depending on their location and extent, particularly in the airway. Case: A 39-year-old male with a history of treated syphilis, hypertension, and Hashimoto’s thyroiditis who presented for persistent facial swelling for three weeks with associated worsening dysphagia, odynophagia, dysphonia, and new facial lesions for the previous six months. He noted the lesions on his face were initially flesh colored, didn’t improve with steroid injections, and became violaceous and generalized. Upon admission, an otolaryngologist performed a bedside flexible laryngoscopy which identified diffuse epiglottic edema and a violaceous lesion on the left epiglottis that extended into the aryepiglottic folds. With serology, he was diagnosed with AIDS and with skin biopsy of his shoulder lesion, diagnosed with KS. He
was started on doxorubicin for his KS, bictegravir/ emtricitabine/tenofovir combination therapy for his AIDS treatment, and was found to have Pneumocystis jirovecii pneumonia, so additionally initiated on atovaquone given a sulfa allergy. He began to improve with treatment; however, he was still noted to have substantial dysphagia with high aspiration risk, requiring percutaneous endoscopic gastrostomy tube placement. Discussion: Laryngeal KS has a low prevalence but clinically significant given the risk for airway obstruction and dysphagia precluding proper nutrition. It is associated with advanced HIV disease but considered to be rare and not well-documented. In a systematic review by Barron et al., there has been a noted male predominance of laryngeal KS with an 8.6:1 ratio with a mean age of 47 years. It commonly presents with dyspnea and hoarseness, primarily affecting the supraglottic region. The standard treatment is initiation/optimization of antiretroviral therapy and systemic chemotherapy with liposomal doxorubicin or paclitaxel. Low-dose radiation therapy can be considered if there is significant airway obstruction or surgical excision as a last resort option.
A RARE CASE OF CARDIOMYOPATHY ASSOCIATED WITH STREPTOCOCCUS ANGINOSUS AND FUSOBACTERIUM NECROPHORUM. Sepehr Sadeghi, Allison Derise, Seth Vignes, Shane Guillory; Louisiana State University, New Orleans, Louisiana.
Introduction: Polymicrobial bloodstream infections can be associated with cardiomyopathy via direct myocardial injury or systemic inflammation. We present a rare case of sepsis-induced cardiomyopathy (SIC) in the setting of Streptococcus anginosus and Fusobacterium necrophorum bacteremia. Case: A 35-year-old female with a history of traumatic right pneumothorax presented with a 1-week history of productive cough, fever, runny nose, sore throat, myalgia, and malaise. Vitals included a fever of 101.2 oF and a pulse of 99 bpm. The exam showed oropharyngeal erythema with exudates, bilateral tonsillar enlargement, and a normal cardiopulmonary
exam. Labs revealed leukocytosis with neutrophilia, lactic acidosis, BNP 988 ng/L, negative troponin, ESR 97 mm/hour, CRP 23 mg/L, and thrombocytopenia at 102,000/mm3. A Chest X-ray was unremarkable, and a CT of the neck showed left-sided tonsillitis without abscess. Respiratory infection panel, sputum cultures, and acid fast bacilli tests were negative. She was started on broad-spectrum antibiotics, later switched to ampicillin-sulbactam after blood cultures grew Streptococcus anginosus and Fusobacterium necrophorum. A transthoracic echocardiogram revealed a reduced ejection fraction (35-40%) and grade 1 diastolic dysfunction. Guideline Directed Medical Therapy (GDMT) was initiated, and follow- 20
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