WHEN INFLAMMATION BEGETS INFLAMMATION Mallory Robichaux, Mitchel Capella, Guido DeJesus; LSUHSC School of Medicine, New Orleans, LA.
Introduction: Macrophage Activation Syndrome (MAS) is a life-threatening complication of rheumatic diseases that is often misdiagnosed due to its constellation of nonspecific findings often encountered in autoimmune disease exacerbations, infectious processes, malignancies, and even some medications. Case: A 36-year-old woman with a medical history of mixed connective tissue disease (MCTD) presented to the Emergency Department with altered mental status and lethargy following 1 week of fever and respiratory symptoms. The day before, she visited an Urgent Care facility and was prescribed amoxicillin. Initial serum chemistries and complete blood count were unrevealing. Cerebrospinal fluid analysis revealed neutrophilic pleocytosis with normal glucose and increased protein concentration. No organisms were identified on Gram stain or microbiologic panel. She was admitted and given broad-spectrum antibiotics and stress-dose corticosteroids. The steroids were stopped because the patient developed steroid-induced psychosis. The patient improved and was discharged 5 days later after CSF cultures were negative. Three days later, she presented again with positional headache, 102.8F fever, and chills. Antibiotics were broadened to IV vancomycin and meropenem, but the patient continued to have high fevers with negative blood cultures. On
hospital day 4, the patient developed palpable splenomegaly and cervical lymphadenopathy. Serum studies on this admission were notable for new-onset pancytopenia and hyperferritinemia. Due to recent culture-negative meningoencephalitis with patient’s history of MCTD, suspicion of an autoinflammatory etiology arose. On hospital day 6, serum showed hypocomplementemia, profound hyperferritinemia, elevated CRP and ESR. Her degree of ferritin elevation and its rapid ascent were felt to be out of proportion to an MCTD flare alone; the most likely diagnosis became Macrophage Activation Syndrome. That day, corticosteroids were restarted despite past adverse effects, with rapid abatement of fever and lymphadenopathy. The patient was discharged with outpatient Rheumatology follow- up and gradual steroid taper. Rheumatology noted resolution of lymphadenopathy, splenomegaly, and laboratory abnormalities. Patient continued steroid taper and began hydroxychloroquine to control lupus component of MCTD. Discussion: Macrophage Activation Syndrome is a dysregulated autoinflammatory response that initially mimics more commonly encountered autoimmune, infectious, and neoplastic processes.
Early recognition of MAS is crucial since it can have significant morbidity and mortality if not diagnosed and treated promptly.
TRANSLATIONAL INVESTIGATION OF SEX DIFFERENCES IN ALCOHOL ANALGESIC EFFICACY: COMPARISON ACROSS PRECLINICAL AND CLINICAL DOMAINS Sumin Lee; LSUHSC School of Medicine, New Orleans, LA.
Introduction: Chronic pain affects over 100 million Americans and significantly contributes to the development and maintenance of alcohol use disorder (AUD). However, the mechanisms underlying the anti-nociceptive effects of alcohol are poorly understood. The goals of the current project were to relate self-reported pain ratings to recent alcohol use in people living with HIV (PLWH) and investigate neuroadaptations in various protein markers produced by alcohol in the central amygdala (CeA) and the insula in an animal model of chronic inflammatory pain.
Alcohol Use in HIV (NOAH) cohort of PLWH completed the SF-36 Survey to report their pain symptoms and interference, while their phosphatidyl-ethanol (PEth) levels were used to assess recent alcohol use. PEth-positive individuals reported fewer pain symptoms and interference compared to PEth- negative individuals, suggesting that recent alcohol use reduces pain ratings in PLWH. Furthermore, women reported higher pain ratings than men, suggesting sex differences in pain experiences in PLWH. To investigate the mechanisms of alcohol-induced analgesia, the complete Freund’s adjuvant (CFA) model of inflammatory pain and intraperitoneal ethanol injection were utilized in 52
Methods/Results: Participants in the New Orleans
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