SPLASH, SOAK, AND SYMPTOMS: A SURPRISING DIAGNOSIS OF LEPTOSPIRAL MENINGITIS Prabhu Ramalingam, Breanna R Campbell, Maitri Acharekar, Sriveni Tangelapelli; Baton Rouge General Hospital, Baton Rouge, LA.
Introduction: Leptospirosis spreads primarily through the urine of infected animals. Humans can become infected via direct contact with contaminated urine or indirectly through water, soil, or food.
opening pressure of 29 cm H₂O and a white blood cell count of 630 cells/mm³, with a mixed lymphocytic and neutrophilic predominance. Cerebrospinal fluid (CSF) analysis showed normal glucose levels but an elevated protein level of 118 mg/dL. The PCR panel was negative, and additional testing for West Nile virus, CSF VDRL, CMV, and EBV was sent and negative. Infectious Diseases sent additional testing for Cryptococcus, serum leptospira, CSF and serum Arbovirus antibody panel, serum Brucella, serum Coxiella, and lymphocytic choriomeningitis panel. . Eventually, labs revealed positive leptospirosis IgM. Doxycycline resolved his symptoms. The case was reported to the state epidemiologist. Discussion: Leptospirosis has a low prevalence, with fewer than ten cases reported annually in our state. The incubation period is two days to four weeks, and symptoms often begin abruptly, sometimes progressing to a more severe second phase as seen in our patient. Despite having this more severe phase, our patient had minimal bilirubin elevation, which is atypical to the usual presentation of marked hyperbilirubinemia.
Case: A 46-year-old male patient with hyperlipidemia and gastroesophageal reflux presented with a headache, fevers, chills, diffuse muscle aches and joint pain for one week. The symptoms began during a family skiing trip in Montana. He did use hot tubs and heated pools on the trip. He denied known encounters with wild animals, animal waste or animal remains, though he recently attended a fundraiser at a horse stable. In his work as civil structure engineer, he performed site visits; recently, he visited a site which had experienced heavy flooding. When his symptoms progressed to throbbing headaches with night sweats, he presented to the emergency department. A complete physical examination was benign without suspicious rashes, skin breaks, or attached ticks. He was found to have a transaminitis, minimal bilirubin elevation, and D-dimer elevation. Imaging of the head, chest, and abdomen were unrevealing. A lumbar puncture revealed an elevated
STATIN-INDUCED MYOPATHY: A CASE OF RESOLUTION WITHOUT IMMUNOSUPPRESSION Monique Fagan, John Huntwork; Tulane University, New Orleans, LA.
Introduction: Statin-induced immune myopathy is a type of immune-mediated necrotizing myopathy and a relatively rare side effect of statins. It results in debilitating myopathy, which may result in permanent loss of function if not diagnosed and treated promptly. Management includes discontinuation of the statin and immunosuppression. In few cases, myopathy resolves with discontinuation of the statin only. Case: A 59-year-old female with coronary artery disease with a myocardial infarction three years prior requiring a high intensity statin presented with a 2-month history of worsening proximal bilateral lower extremity weakness and myalgia. The physical examination revealed a grade 3/5
strength in the proximal muscles of both lower extremities. Lab investigation revealed elevated Creatine Kinase (CK) at 13245 IU/L and an initial diagnosis of rhabdomyolysis was made. After minimal response to treatment, workup for Statin-induced immune myopathy was done. Anti-HMGCR titer was positive at 52 units and a MRI showed symmetric myositis of bilateral proximal lower extremity musculature. The patient opted for expectant management, without immunosuppression despite being counseled on the possibility of irreversible muscle damage. Statin discontinuation without immunosuppression resulted in complete resolution of myopathy and improved CK levels to 600 IU/L in 9 months after initial presentation.
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