fungating, and necrotic non-bleeding mass of malignant appearance in the lesser curvature of the stomach. It measured 15 cm in diameter. Multiple cold forceps biopsies were taken. Histology was consistent with high-grade, poorly-differentiated small cell neuroendocrine carcinoma. Staging PET scan revealed a hypermetabolic gastric body mass with a solitary metastasis to a gastrohepatic lymph node. Patient was started on chemotherapy with carboplatin, etoposide, and atezolizumab with plans for later initiation of radiation therapy.
that usually occurs in the gastrointestinal and genitourinary systems. A key difference between gastrointestinal and pulmonary SCC is the lack of necessity for cranial irradiation because the former is associated with a lower incidence of brain metastases. EPSCC usually necessitates multimodal therapy to improve outcomes. Surgery, chemotherapy, and radiation are the available options, and these can be done in combination depending on staging. Data is very limited on optimal sequence of therapy, and current therapy is guided from previous guidelines on pulmonary SCC.
Discussion: EPSCC is a rare, aggressive neoplasm
A CASE OF PLASMODIUM FALCIPARUM (P. FALCIPARUM) INFECTION Zui Keat Ng, Christopher Chedid, Ibrahim Shenawi, Joseph Prechter, Karen Curry; Department of Medicine, LSU Health Sciences Center, Lafayette, LA.
Introduction: Malaria is caused by plasmodium parasites which are commonly spread to humans by feeding Anopheles mosquitoes. Common symptoms include fever, headache, myalgia, and fatigue. Case: A 24-year-old male presented with complaints of subjective fever, diaphoresis, blurry vision, and progressive weakness. He had returned from Ivory Coast, West Africa 10 days prior after living there for 2 years where he completed mission work requiring him to walk long distances daily. The patient reported compliance with doxycycline prophylaxis throughout his stay in Africa. He was up to date with immunizations but had not continued doxycycline for the prescribed 4 weeks after leaving Africa. On initial presentation, he was septic with BP 80/50 and HR 130. His labs were as follows: WBC 15,300, PLT 53,000, D-Dimer>20, Glucose 58, LDH 284, CRP 127. His peripheral smear showed microorganism growth consistent with P. falciparum infection, parasitemia > 30%. He was started on oral Atovaquone-Proguanil and doxycycline until the Artesunate IV arrived from the CDC. Gradual clinical improvement of his severe malarial infection was observed after 4
days of Artesunate IV as evidenced by resolution of symptoms and maintenance of hemodynamic stability. He was discharged with a short course of malarone and his outpatient lab work did not show any signs of delayed hemolytic anemia. Discussion: Malaria is a serious public health issue affecting poor tropical countries. In areas with high transmission, the most vulnerable groups include young children, pregnant women, and travelers who come from areas with a low prevalence of malaria due to lack of immunity. Peripheral blood smear remains the gold standard for laboratory confirmation of malaria. Our patient’s blood smear showed the presence of infected red blood cells (RBCs) with classic Appliqué forms and crescent- shaped gametocytes. Thrombocytopenia can also be a diagnostic marker for malaria in patients with acute febrile illness and in those with a high pretest probability for the infection. Artesunate with prophylaxis therapy including mefloquine, doxycycline, and malarone is still the standard first line treatment for severe P. falciparum infection.
SEVERE GENERALIZED MYOSITIS AFTER COVID-19 Amanda Ritchie, Brian Barbara, John Amoss; Department of Medicine, LSU Health Sciences Center, New Orleans, LA.
Introduction: Myositis is a rare group of diseases characterized by inflamed muscles, which can cause prolonged muscle fatigue and weakness. The group includes the autoimmune disorders juvenile myositis, dermatomyositis and polymyositis,
as well as inclusion body myositis (IBM).
Case: A 33-year-old woman with anxiety, elevated DHEA, chronic pelvic pain on naproxen and COVID-19 infection 3 months prior after vaccination presented 20
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