transverse colon to the sigmoid colon consistent with colitis. Polymerase chain reaction (PCR) for CDI was negative. On a subsequent examination, the patient was noted to have a crescendo- decrescendo systolic murmur which prompted an echocardiogram that revealed critical aortic stenosis (transaortic velocity of >4 m/s, aortic valve mean pressure gradient of 54 mmHg, and aortic valve area of 0.88 cm2). Due to the persistence of gastrointestinal symptoms, the patient underwent colonoscopy which revealed a pseudomembrane- like appearance of the mid-transverse to sigmoid colon concerning for Clostridioides difficile colitis. A second PCR for CDI infection was negative. Intestinal biopsies were consistent with ischemic colitis.
After further investigation, this episode was the patient’s second presentation of colonic ischemia, making an underlying cardiovascular etiology likely. Definitive treatment of the aortic stenosis was completed with successful transcatheter aortic valvular replacement two weeks after discharge. Discussion: This patient was thought to have CDI with endoscopic appearance of pseudomembranous colitis but was found to have colonic ischemia secondary to intravascular volume depletion in the setting of critical aortic stenosis. This case highlights the importance of consideration of colonic ischemia as a mimicker of infectious pseudomembranous colitis.
CASE OF STUBBORN KERATOCONJUNCTIVITIS! Aleeza Qamar, Syeda Nida, Kinza Muzaffar; Louisiana State University, Shreveport, LA.
Introduction: We present a case of recurrent keratoconjunctivitis refractory to antibiotics and steroid eye drops.
vessel ischemic changes. Assuming an underlying autoimmune etiology, methotrexate 10 mg was started while waiting for the biopsy to be performed. Methotrexate helped improve her symptoms, and the biopsy revealed mucous membrane pemphigoid (MMP). The patient was then started on prednisone and intravenous cyclophosphamide infusions while methotrexate was discontinued. Since the initiation of cyclophosphamide infusions and prednisone, the patient reported complete resolution of ocular symptoms, and she is able to perform activities of daily living. Discussion: Mucous membrane pemphigoid (MMP) is characterized as a rare, blistering, autoimmune disorder usually involving mucosal membranes of the skin, with oral and ocular mucosa less likely sites to be affected. Early diagnosis is challenging due to non-specific symptoms but is crucial to prevent severe outcomes and scarring, which can be irreversible, especially in ocular cases leading to blindness. Treatment varies by severity and site, ranging from topical therapy for low-risk patients to systemic immunosuppressive therapy for high-risk patients. Effective management of MMP requires early intervention and timely collaboration among relevant specialists.
Case: 40-year-old female with recurrent keratoconjunctivitis who presented to the
ophthalmology clinic for eye redness, irritation, bulging and swelling of eyes and eyelids along with blurry vision, which has been limiting her activities of daily living. Per ophthalmology, she was found to have superior limbic keratoconjunctivitis, that was treated with antibiotics and steroid drops which initially improved her symptoms. Due to bulging of the eyes, further work up was performed. Anti TPO antibodies were negative, and thyroid ultrasound revealed mild enlargement of right lobe and hypervascularity. Additionally, ANA titers were positive, 1:80 with homogeneous pattern and a negative reflex panel. HIV, tuberculosis, syphilis, Lyme disease, rheumatoid factor, ACE levels, lysozymes, HLA b27, vasculitis panel and sarcoidosis work up was unremarkable. After antibiotic course, keratoconjunctivitis returned, and was no longer responding to antibiotics or steroid eyedrops. Conjunctival biopsy was attempted however, the procedure was aborted due to active keratitis. The MRI of the brain suggested chronic small-
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