and pulsus paradoxus. Pertinent echocardiographic findings include early diastolic collapse of the RV (seen in this patient), late diastolic collapse of the right atrium, and abnormal septal motion. The doppler would demonstrate >25% reduction in mitral inflow velocity with inspiration. Tamponade is life-
threatening and typically requires pericardiocentesis or a pericardial window to relieve pressure on the heart. The possibility of tamponade without significant pericardial effusion is an important consideration, as it influences medical management.
PROBABLE NEUROSARCOIDOSIS – A RARE DIAGNOSIS IN A 56-YEAR-OLD FEMALE WITH FACIAL NERVE PALSY Keval Thakkar, Sarmand Jameel, Naveed Asim; Willis-Knighton Medical Center, Shreveport, LA.
Introduction: Sarcoidosis continues to remain a diagnosis of exclusion. About 5-20% of patients diagnosed with systemic sarcoidosis can develop neurological manifestations which can lead to neurosarcoidosis (NS). NS encompasses a wide range of symptoms including but not limited to cranial neuropathies, myelopathies, parenchymal disease, encephalopathy, neuropsychiatric illness and peripheral neuropathy. A diagnostic challenge arises when patients often present with neurological symptoms mimicking other pathologies without prior evidence of systemic sarcoid disease. Case: A 56-year-old female who presented with sudden onset lower motor left-sided facial weakness, inability to close her left eye and left perioral numbness. Past medical history included a recent hospitalization for pneumonia, during which mediastinal adenopathy was noted on imaging, however, follow-up care was not pursued afterward. Neurological examination revealed left facial droop and inability to raise her eyebrows which led to further investigations. A repeat CT of the chest was positive for granulomatous process involvement which was further confirmed with a
lymph node biopsy obtained with endobronchial ultrasound. The MRI of the brain revealed slight asymmetric increased enhancement of the left geniculate ganglion with cerebrospinal fluid analysis positive for increased protein and ACE levels. A diagnosis of ‘probable neurosarcoidosis’ was confirmed after ruling out other etiologies with several investigations. The patient responded favorably with corticosteroid treatment and with partial resolution of her facial nerve palsy symptoms. Discussion: This case reflects on the importance of high clinical suspicion in patients presenting with unexplained neurological symptoms, especially in those with no prior evidence of systemic sarcoidosis and exclusion of other possible etiologies. Prompt diagnosis and timely management can reduce neurologic complications. Given the spectrum of varied presentations and imprecise diagnostic tests, neurosarcoidosis continues to remain a complex condition that requires increased awareness among clinicians. Additional research is crucial to improve diagnostic accuracy and develop more effective treatment strategies.
PURPLE RAIN: A RARE CASE OF PURPLE URINE BAG SYNDROME Jasleen Hora, Madison Peschen, James Crowe; Leonard J Chabert Medical Center, Houma, LA
Introduction: Purple Urine Bag Syndrome (PUBS) is a rare and visually striking process of a urinary tract infection. The pathogenesis revolves around the metabolism of tryptophan to indole by bacteria, which is later converted to indicant in the liver. This metabolite is then broken down in the urine by sulphatase and phosphatase enzymes
by the bacteria resulting in an indigo color in alkaline environments (urine). Bacterial species associated with PUBS include Escherichia coli, Enterococcus species, Pseudomonas species. Case: A 73-year-old male with a chronic indwelling foley catheter secondary to urinary retention was 45
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