dependent acute kidney injury and pancreatitis, the patient ultimately survived his injuries and was downgraded to the floor in stable condition. Discussion: Aortic dissection is a rare complication of SLE, with few reported cases in the literature. To our knowledge, this is the first case of recurrent aortic dissection in a patient with SLE. Poor control of SLE, smoking history, and hypertension all contributed some degree to the vascular insult
and allowed progression into a life-threatening complication requiring urgent surgical intervention. It is important to consider aortic dissection in SLE patients who present with severe chest or back pain, even those patients with history of known aortic dissections requiring repair. Preventative care to reduce modifiable risk factors and reduce autoimmune activity in the outpatient setting could help prevent further life-threatening complications.
A FATAL CASE OF KAPOSI SARCOMA IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (KS-IRIS) Chelsi M. Robertson, Ibrahim Shenawi, Andrew Carbajal, Yazan Alqara, Shalini Paliwal, Gregory Ardoin; Department of Medicine, LSU Health Sciences Center, Lafayette, LA.
Introduction: IRIS is a state of hyperinflammatory response that occurs in the first six months of treatment of HIV/AIDS patients. Potentially, it is a complication of the use of HAART therapy in patients naïve to these medications. This hyper-inflammatory response happens against undiagnosed or previously diagnosed latent infections after CD4 cell counts improve with a subsequent immune response. The immune response to these infections could lead to illness or death. This case is a rare presentation of KS-IRIS. Case: 50-year-old male with HIV infection and medication noncompliance was hospitalized in April 2022 for PJP. During hospitalization, skin lesions located on the back and neck were biopsy-confirmed KS. HAART therapy was initiated with Descovy and Tivicay increasing his CD4 count from 31 to 205 over time. The patient later returned with worsening shortness of breath and facial plethora. ENT was consulted and performed a bedside laryngoscopy revealing epiglottal Kaposi lesions. CT Chest with contrast revealed scattered nodules throughout the lungs. He was treated supportively and discharged for Hematology/Oncology follow-up for consideration of liposomal doxorubicin chemotherapy initiation.
At a follow-up appointment with Infectious Disease two weeks after his presentation, labs revealed a CD4 count of 83 and viral load of 21. At the time, the patient had severe jaundice and scleral icterus. Subsequent labs revealed an alkaline phosphatase of 2145 and bilirubin of 37.4. Follow-up CT imaging revealed worsened scattered nodules throughout lungs and new liver masses, concerning for diffuse KS with liver involvement. He was admitted and found to have obstructive cholangitis due to tumor metastasis. Despite ERCP with stent placement, his clinical course worsened, and the patient developed hepatic encephalopathy. Due to diffuse KS and inability to receive chemotherapy given his liver failure, the decision was made for hospice. Unfortunately, the patient passed away before his transition. Discussion: IRIS is a collection of inflammatory disorders with subsequent exacerbation of preexisting infections following the initiation ART therapy. Clinicians should be cognizant of IRIS when treating patients with HIV/AIDS infection. In such patients, it is imperative to obtain a thorough medical history and laboratory workup, including CD4 count and viral load.
UTILITY OF FRUCTOSAMINE TO ASSESS GLYCEMIC CONTROL Ashley Misky, Betty Lo, Lee Engel; Department of Medicine, LSU Health Sciences Center, New Orleans, LA.
Introduction: Fructosamine, a rapid, inexpensive test, should be considered in patients with certain conditions that may lead to falsely elevated or lowered HbA1C like: hemoglobinopathies (thalassemia or hemoglobin variants) and
conditions that can affect erythrocyte life span (hemolytic anemia, blood loss, iron deficiency anemia, aplastic anemia, HIV, pregnancy, chronic liver or kidney disease).
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