anemia with hemoglobin of 7.7, and electrolytes within normal limits. The initial procalcitonin level was 0.2 but rose to 3.2 after six hours. A chest radiograph shows mild cardiomegaly with stable pulmonary granulomas without new infiltrates or consolidations. A urinalysis shows no pyuria with negative leukocyte esterase and nitrites. Influenza and Covid PCR were negative. Blood and urine cultures were collected, with empiric vancomycin and cefepime started and prednisone held.
typically develop multi-systemic inflammatory and hematologic signs and symptoms, including fever, chondritis, arthritis, skin rashes, medium-vessel vasculitis and pulmonary infiltrate among others. While there is no specific treatment yet developed for VEXAS, steroids and other immunosuppressants are often used to help prevent and quell flare-ups, which increases patients' risk for infection. Under these circumstances, it is critical to investigate infectious versus autoimmune etiologies when patients with VEXAS present with new-onset fever.
Discussion: Patients with VEXAS syndrome
A LONG WAY FROM HOME: AN INTERESTING CASE OF MSSA BACTEREMIA FROM AN UNKNOWN SOURCE Magnus Chun, Giuseppe Tripodi, Phi N. Luong, Constance Gistand; Tulane University School of Medicine, New Orleans, LA.
Introduction: Staphylococcus aureus is the leading cause of hospital- and community-acquired bacteremia. MSSA bacteremia has frequently been reported to be associated with deep tissue infection, but rarely has it been associated with empyema secondary to septic emboli. It is important to determine the etiology and appropriate medical management for patients with MSSA bacteremia. Case: A 48-year-old immunocompetent man with hypertension was admitted for a 2-day history of abdominal pain radiating to the pelvis and dyspnea since recently flying domestically. Additional history revealed diaphoresis, dyspnea, nausea, vomiting, and non-bloody diarrhea 2-3 hours following a large meal upon arrival. Examination demonstrated diffuse abdominal tenderness to palpitation and distension. Of significant note, the patient has had significant upper periodontal swelling for past few weeks. CT chest identified peripheral wedge-shaped consolidations suggestive of multifocal infectious process consistent with septic emboli. EKG showed sinus tachycardia with S1Q3T3 pattern. Peripheral blood cultures were positive for methicillin-
sensitive Staphylococcus aureus (MSSA). His hospital course was prolonged and complicated by orbital cellulitis and bilateral empyema. Additionally, he developed acute hypo xic respiratory failure causing him to decompensate and requiring intubation. Heparin drip was initiated after clinical suspicion of pulmonary emboli on admission. Patient was put on intravenous (IV) Ancef after initial positive blood culture for MSSA. Upon discharge, the final treatment plan for this patient is IV Ancef for an additional 6 weeks via PICC line infusion in his home state. Discussion: The source of his MSSA bacteremia remains unknown, but we suspect it was caused by his empyema secondary to septic emboli, prompting further investigation. Etiology of his septic emboli could be secondary to periodontal abscess, infected upper extremity hardware, Infected intravenous line, a common source of hospital-acquired infection or foodborne illness on arrival after prolonged immobility on a plane. Endocarditis, though unlikely as an echocardiogram, was negative for valvular vegetations.
WORKUP AND MANAGEMENT OF BEHCET’S DISEASE ASSOCIATED WITH SERONEGATIVE ARTHRITIS Elizabeth Holland, Kelly Chau; LSUHSC School of Medicine, New Orleans, LA.
Introduction: Behcet’s disease is a rare inflammatory disorder characterized by uveitis, skin lesions and painful lesions of oral and genital mucosa affecting more than 15,000 patients in the US. In a majority of cases, polyarthritis is observed,
and GI, CNS, or vascular involvement is seen in a smaller percentage of cases. These patients experience painful episodic relapses lasting weeks at a time. The etiology of this syndrome is poorly understood and believed to be a multifactorial 50
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