importance of recognizing endogenous bacterial endophthalmitis in patients with MRSA bacteremia presenting with new ocular symptoms. Rapid
diagnosis and aggressive therapy are crucial to prevent irreversible visual impairment and manage associated systemic risks.
OPIOID-INDUCED INTRAHEPATIC CHOLESTASIS IN HEMOGLOBIN SC DISEASE: A CHALLENGING ISSUE IN MANAGEMENT Usman Haq, Susmitha D Chalamalasetti, Anam Shahid, Navin Ramlal; St. Francis Medical Center, Monroe, LA.
Introduction: Sickle cell disease (SCD) is an inherited autosomal recessive disorder caused by a chromosome 11 mutation. This results in the production of abnormal hemoglobin S (HbS), leading to rigid red blood cells that can obstruct small blood vessels causing ischemic tissue injury, chronic hemolytic anemia, and various systemic complications. Hemoglobin SC (HbSC) disease occurs when an individual inherits one HbS gene and one HbC gene. Although HbSC is often considered milder than HbSS, it can still cause significant complications Case: A 48-year-old male with sickle cell HbSC disease, proliferative retinopathy and avascular necrosis presented with severe generalized pain. He was afebrile, tachycardic, tachypneic, and hypertensive on arrival. The patient was admitted for sickle cell pain crisis and managed with intravenous fluids and hydromorphone. Despite scheduled hydromorphone, his pain intensified requiring additional doses of pain medications. His hospital course was complicated by worsening icterus and pruritus. Repeat labs revealed hyperbilirubinemia with a peak total bilirubin of 19 mg/dl and direct bilirubin of 13.4 mg/dl. Other lab work for liver injury was unremarkable, as was a right upper
quadrant ultrasound and magnetic resonance cholangiopancreatography. With no identifiable cause for hyperbilirubinemia a decision was made to discontinue hydromorphone. After discontinuation, the patient showed significant improvement in symptoms and lab results, with bilirubin levels gradually down trending. He also experienced relief from pain, pruritus, and scleral icterus and was discharged in stable condition. Discussion: This case describes intrahepatic cholestasis in a patient with hemoglobin SC disease, triggered by hydromorphone (Dilaudid), a commonly prescribed opioid for managing sickle cell pain crises. In our patient, opioid-induced cholestasis was identified as the likely cause of conjugated hyperbilirubinemia after ruling out extrahepatic obstruction and active hemolysis. The patient’s marked improvement after discontinuation of hydromorphone highlighted the need to consider cholestasis as a potential complication of high- dose opioid use in sickle cell patients. Early recognition and discontinuation of the opioid may help differentiate opioid induced cholestasis from serious complications like sickle cell hepatopathy
PACEMAKER SYNDROME - A DYSSYNCHRONOUS FUTURE Brandon Dang, Sepehr Sadeghi, Jamie Tran, Thomas Deiss, Andree Judd, Ashley Van, Sanjay Kamboj, Pramilla Subramaniam, Jose Barrientos Paz; Louisiana State University, New Orleans, LA.
Introduction: Intradialysis hypotension (IDH) is the most common complication experienced in patients undergoing hemodialysis (HD) sessions with a frequency of up to 12%. This risk may be increased in patients with leadless ventricular pacemakers due to atrial and ventricular dyssynchrony, a phenomenon known as pacemaker syndrome.
Case: A 71-year-old male with hypertension, type II diabetes mellitus, end stage renal disease on hemodialysis via a tunneled central venous catheter (CVC), and single chamber leadless pacemaker presented after developing chest pain and hypotension during hemodialysis. He had three emergency room visits for the same presentation within the two previous weeks. An 43
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