months after the medications were discontinued.
reduction of symptoms following discontinuation of hydrochlorothiazide and lisinopril favors the diagnosis of drug-eruption. Her concurrent symptoms of wheezing, diarrhea, and hypotensive episodes fit the symptoms of mastocytosis, but were possibly concurrent sequelae of her untreated HIV infection. This case presents an interesting scenario where adverse drug reactions and uncontrolled HIV mimicked the presentation of mastocytosis.
Discussion: Although serum tryptase is classically elevated with mastocytosis, a normal tryptase has been documented in cases of the cutaneous mastocytosis subtype. However, this patient did not show any indication of elevated mast cells on either bone marrow or forearm punch biopsy, which would be expected in mastocytosis. The
THE LINK BETWEEN BANANAS AND RHINITIS David Van, Stacy Knowles, Sanjay Kamboj; Department of Medicine, LSU Health Sciences Center, New Orleans, LA.
Introduction: Food Pollen Allergy Syndrome (FPAS) commonly occurs in patients who suffer from allergic rhinitis due to pollen exposure. Common foods such as raw fruits, vegetables, seeds, and nuts contain the pathogenesis-related Class-10 (PRP10) protein which have many similar components to pollen proteins. Case: A 40-year-old man with chronic allergic rhinitis presented to the Allergy and Immunology clinic for a primary complaint of seasonal allergies induced by pollen. His main symptoms included sneezing, watery eyes, throat irritation, rhinorrhea, and nasal congestion. The symptoms recur annually, typically in late spring. He also experiences oral discomfort and laryngospasm with consumption of raw fruit, especially bananas, plums, and almonds. Of note, when these foods are cooked, he experiences none of the symptoms. When eating these foods, he does not experience hives, hypotension, or angioedema. His physical exam was significant for tenderness of the maxillary sinuses, rhinorrhea,
oropharyngeal erythema, and clear, watery ocular discharge. His IgE based allergy profile was significant for high levels of IgE to Silver Birch and White Oak trees, as well as Bermuda and Timothy grasses. He was treated empirically with cetirizine, fluticasone nasal spray, and saline nasal rinses. He was also urged to avoid triggering raw foods when possible, and to log a food diary to document the offending foods and the subsequent reactions. Discussion: Diagnostic proteomics with the pathogenesis-related class-10 protein family enables physicians to identify the associated plants a foods that patients should avoid. For this patient, the birch tree allergen Bet v1 is cross reactive with the Rosacea plant family which includes plums and nuts. Similarly, the Bet v6 peptide and Que 1 peptide are both from the birch and oak tree family, which is cross reactive to bananas. This case is important for physicians as the allergic rhinitis symptoms may be due to an underlying food pollen allergy.
A CASE OF SYSTEMIC THROMBOSIS IN CULTURE NEGATIVE BACTERIAL MENINGITIS Simin Khan, Maamannan Venkataraj, Shidestini Martinez, Sheryl Sabillo; Department of Medicine, Louisiana State University, Shreveport, LA.
Introduction: Patients with infections or other inflammatory states are at higher risk of initial and recurrent thromboembolic states. There have been case reports of strokes associated with meningitis in the past but very few cases of meningitis with pulmonary embolism. Case: A 62 year old male with hypertension and hyperlipidemia presented with severe headache, fever, chills, fatigue for 5 days followed by chest pain for 2 days. He denied any shortness of breath. He described the headache as the worst headache
of his life. His chest pain was sub-sternal, non- radiating, worsening with inspiration. His vitals were stable, blood work showed WBC count of 13K and sodium of 125. EKG had TWI in lateral leads, troponin and D-dimer were marginally elevated. Even with low probability, Chest CT angiogram was obtained which showed pulmonary embolism in the lingular pulmonary artery and patient was started on Eliquis. CT brain on arrival was negative for any acute intracranial abnormality. MRI brain showed an acute lacunar infarction even though the patient had no neurological deficits. The patient had 33
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