the patient goes into a pulseless electrical activity arrest followed by asystole with the patient expiring.
benefit, prophylactic steroids (supported by the LPA99 trial) remain the mainstay of preventing and reducing severity of DS. Sometimes even temporary discontinuation of ATRA maybe required until end-organ damage shows improvement. While this patient had a de novo diagnosis of APML a particularly aggressive hematologic malignancy, we believe he ultimately succumbed to DS.
Discussion: It is believed that about 25% of patients with APML, undergoing induction therapy with the ATRA, will develop DS. ATRA is known to cause cellular migration, endothelial activation, and tissue damage from interleukins, which is believed to cause DS. Although they have not shown any mortality
UNVEILING THE SPOTS: ACUTE VISION LOSS AND POSITIVE AUTOANTIBODIES Ellen Mire, Catherine Loehr, Shane Sanne; Louisiana State University, New Orleans, LA.
Introduction: Autoimmune diseases often coexist. When a young patient, such as in this case, presents with uncontrolled diabetes and severe hypertension concomitantly, autoimmune diseases like type I diabetes mellitus (DM) and systemic lupus erythematosus (SLE) should be considered. Case: A 37-year-old female with hypertension, hyperlipidemia, and poorly controlled type II diabetes mellitus (DM) (A1c of 11.4) presented to an outside hospital with acute-onset vision loss in the left eye. The patient was transferred to our primary hospital for an ophthalmology consult and hypertensive emergency (blood pressure 260/120 mmHg). The morning of presentation, she had woken up and noticed “spots” over her central vision in her left eye. Her vision loss was sudden, painless, and had never happened before. Ophthalmology did not recommend operative management but follow up with a retina specialist. They believed her decreased vision was most consistent with severe diabetic and hypertensive retinopathy. There was low suspicion for central retinal artery occlusion, though it could not fully be ruled out. She was encouraged to follow
closely with her primary care and endocrinologist teams for further work up due to concern for diabetic and hypertensive nephropathy. While inpatient, an antinuclear antibody (ANA) screen with reflex was collected due to concern for an autoimmune process given the severity of her presentation. After discharge, she was found to be positive for ANA and anti-Sjögren’s-syndrome-related antigen A (anti-SSA) antibodies (5.2 antibody index [AI], upper limit of normal < 1.0 AI), often consistent with SLE or Sjögren’s syndrome. All other antibodies were negative. Her care team recommended rheumatology referral for connective tissue disease work-up. Discussion: Given the severity of her hypertension and diabetes, underlying autoimmune diseases like SLE and type I DM were included on the differential diagnosis. In the setting of positive autoantibodies, further rheumatologic work-up is needed for this patient, and the etiology of her diabetes can be reconsidered. This case report highlights the importance of a broad differential diagnosis and suspicion for autoimmune disease in a patient presenting with multiple comorbidities.
UNVEILING VARICELLA ZOSTER MENINGITIS: STROKE-LIKE SYMPTOMS AS INITIAL PRESENTATION IN AN IMMUNOCOMPETENT ADULT Marley Lee, Micha Pitzen, Siva Parcha; Louisiana State University, New Orleans, LA.
Introduction: Shingles, or herpes zoster, is a painful viral infection from the reactivation of varicella-zoster virus (VZV). It typically appears as a band-like rash on one side of the body and can cause “stroke-like” neurological symptoms
in some cases. The reactivation, though still misunderstood, is thought to occur due to factors such as aging and a declining immune system
Case: A 50-year-old African American female with
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