at the graft site during surgery, confirming it as the source of infection. After removal, her blood cultures cleared, and leukocytosis resolved. The patient was then discharged home in stable condition. Discussion: The management of A. xylosoxidans infections, particularly in immunocompromised patients, poses significant challenges due to the pathogen’s intrinsic resistance to multiple antibiotics and its ability to form biofilms. These characteristics complicate treatment and often
necessitate the removal of infected medical devices, as seen in this case where the infection persisted despite broad-spectrum antibiotics. This case highlights the importance of early recognition of A. xylosoxidans’ predilection for indwelling medical devices and grafts, and the probable need for their removal if there is persistent bacteremia despite prolonged antibiotic use, in an effort to achieve better clinical outcomes and prevent further morbidity and mortality.
ACUTE ABDOMINAL PAIN AS A RARE PRESENTATION OF MEMBRANOUS NEPHROPATHY: CASE OF SUPERIOR MESENTERIC VEIN THROMBOSIS. Jacob Cunningham, Melisa Harrington; Louisiana State University, Lafayette, LA.
Introduction: Membranous nephropathy is one of the most common causes of nephrotic syndrome in adults. Patients with nephrotic syndrome are at increased risk of thrombus formation due to urinary loss of anti-thrombin III, protein C, protein S, and plasminogen. Case: A 54-year-old male with no known past medical history presented with five days of generalized abdominal pain and bloating that was rated as 7/10 on the pain scale. He took ibuprofen 800 mg twice daily for three days without improvement. The pain did not worsen with meals although his appetite was decreased. He had a bowel movement one day before presentation of soft, without melena or hematochezia. A CT of the abdomen and pelvis with contrast revealed occlusive thrombus in the superior mesenteric vein and edematous loops of small bowel within distal jejunum and proximal ileum concerning for impending bowel infarction. The patient was assessed by surgery with no surgical intervention indicated. Labs revealed elevated renal indices with BUN 26 mmol/L, creatinine 1.42 mg/dL.
Urinalysis revealed 4+ protein, 24-hour urine protein collection with 16,219.7 mg/24h. A heparin drip was initiated, and he was placed NPO. Throughout the hospital course the patient’s symptoms significantly improved and he tolerated a diet. He was discharged on apixaban and lisinopril-hydrochlorothiazide. Following discharge, resulting labs revealed PLA-2R antibody elevated at 73 RU/mL. Renal biopsy was obtained which was consistent with membranous nephropathy. A repeat CT of the abdomen and pelvis two weeks following discharge revealed persistent superior mesenteric vein thrombus which was improved compared to initial imaging. There has been no recurrence of the patient’s abdominal pain since the initial presentation. Discussion: The presentation of venous thrombosis in patients with membranous nephropathy is common although thrombosis typically involves deep veins in the lower extremities. The findings of superior mesenteric vein thrombosis illustrate the variable presentation of membranous nephropathy and the relation between kidney disease and vascular health.
AN ATYPICAL PRESENTATION OF PROSTHETIC VALVE ENDOCARDITIS: A CASE OF STAPHYLOCOCCUS HAEMOLYTICUS. Jason Onwenu, Brandon Dang, Sepehr Sadeghi, Gurtaj Mahil, Jamie Tran, Ashley Van, Ross McCarron, Pramilla Subramaniam; Louisiana State University, New Orleans, LA.
Introduction: Prosthetic valve endocarditis (PVE) is commonly caused by Staphylococcus aureus,
α-hemolytic streptococci, and enterococci in 80% of cases. The following case shows an unusual 23
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