strategies. Data is limited regarding the spectra of antimicrobial activity for this organism, but the
few other available case reports suggest success with penicillin derivatives and metronidazole.
CODE BLUE GREEN: INCLUSIONS OF DOOM. Daniel Zamanian, Arpita Pawa, Christopher Trosclair; Willis-Knighton Medical Center, Shreveport, LA.
Introduction: Blue-green neutrophilic inclusions are rare and associated with high morbidity and mortality, particularly in multi-organ failure and sepsis. Their exact composition is unclear, with some suggesting they contain biliverdin, a byproduct of liver damage. These inclusions are observed in peripheral smears using wright-giemsa staining and are increasingly recognized as a sign of impending deterioration in critically ill patients. Case 1: A 50-year-old male with diabetes, end- stage renal disease, and a recent kidney-pancreas transplant was found unresponsive at home. He had a history of multidrug-resistant infections and developed Klebsiella pneumoniae sepsis. His condition deteriorated despite broad- spectrum antibiotics and antiviral therapy for concurrent cytomegalovirus and BK viremia. Green cytoplasmic crystals were noted in neutrophils shortly before his death from cardiac arrest. Case 2: A 79-year-old female with coronary artery disease, diabetes, and chronic kidney disease presented with confusion post-hemodialysis. She had recently undergone coronary artery stenting for a non-ST elevation myocardial infarction. Despite
initial antibiotic treatment for suspected sepsis, she developed shock, multi-organ failure, and cardiac arrest. Blue-green neutrophilic inclusions were detected hours before her death, highlighting their association with severe disease progression. Case 3: An 87-year-old male with atrial fibrillation, hypertension, and hyperlipidemia was admitted with worsening dyspnea and renal dysfunction. After initial stabilization with direct current cardioversion for atrial fibrillation, his condition deteriorated, developing respiratory failure, sepsis, and multi- organ failure. Blue-green neutrophilic inclusions were noted shortly before his death, raising concerns about their role in his rapid clinical decline. Discussion: Blue-green neutrophilic inclusions are increasingly recognized in critically ill patients, often preceding rapid deterioration and death. Though their composition is unclear, they may result from severe systemic inflammation, hepatic dysfunction, or sepsis. In all three cases, these inclusions were observed shortly before death, highlighting their potential as a marker of poor prognosis in critically ill individuals. Further research is needed to explore their role and potential as a prognostic tool.
CRYPTOCOCCAL MENINGITIS MIMICKING METASTATIC BRAIN DISEASE: A DIAGNOSTIC CHALLENGE. Sham Kumar, Kayla Ashley Irons, Ram Kumar, Rahul Robaish Kumar, Harikrishna Bandla; St. Francis Medical Center, Monroe, LA.
Introduction: Cryptococcosis, a serious fungal infection caused by the yeast-like fungus Cryptococcus neoformans, primarily affects immunocompromised individuals, including those with HIV/AIDS or organ transplant recipients. Although less common, Cryptococcus neoformans infections can also occur in immunocompetent adults.
of dizziness, chronic dull headaches, and multiple falls was initially referred to an Otolaryngology (ENT) specialist by her primary care physician for further evaluation. Initial work up, including routine labs, had all been unremarkable. An MRI of the brain, per ENT recommendations, revealed two punctate foci of enhancement in the posterior right parietal lobe and lower left cerebellum, raising concerns for metastatic brain disease. The patient was then referred to an oncologist, who conducted a thorough metastatic 28
Case: A 72-year-old female with a several-year history
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