without miosis, left side tongue deviation and slightly slurred speech. CT scan of the head without contrast was unremarkable. Suspecting cranial neuropathies, possibly related to COVID-19 infection, head MRI and subsequently neck MRI were ordered and they revealed an avidly enhancing lesion at the jugular foramen with inferior extent in the left neck area (5.5 x 1.5 cm), demonstrating complete encasement of the left internal carotid artery with preserved flow. On further questioning, patient reported occasional dysphonia, pulsatile tinnitus, ear fullness, and chronic hearing loss, presumed to be related
Meniere disease. The patient was discharged with Endocrinology and ENT outpatient follow-up for evaluation of functional status and treatment options. Discussion: The case reflects an atypical presentation of head and neck paraganglioma with suspected acute Horner’s syndrome and hypoglossal nerve palsy (CN XII), presumed to be secondary to tumor engorgement and mass effect. Signs of jugular foramen syndrome (CN IX, X, XI dysfunction) would have been more expected.
ORAL PRESENTATIONS – RESIDENTS SESSION 2
ACUTE UNILATERAL ANTERIOR UVEITIS AS A PRESENTING MANIFESTATION OF TERTIARY SYPHILIS IN A YOUNG CAUCASIAN MALE Dhruvkumar Patel, Suyog Patel, Anuj Thakre, Shivani Sharma, Nitesh Gandhi; Department of Medicine, Louisiana State University, Shreveport, LA.
Introduction: Secondary and tertiary syphilis may have atypical and complex presentations. It can rarely present with isolated ophthalmic manifestations. Case: A 37-year-old male with Hepatitis C presented with left eye pain, redness, blurry vision, and photosensitivity of 5 days duration. Symptoms were associated with episodes of unilateral, squeezing, occipital-frontal headache. He denied any fever, chills, rash or injury to the eye. He consumed alcohol (1-2 glasses/day) and is also a non-IV drug user. He reported multiple male sexual partners. He was initially prescribed polymyxin B-trimethoprim eye drops by urgent care with no improvement in symptoms. He was later seen at the ophthalmology clinic where he was diagnosed with anterior uveitis of the left eye. A full uveitis workup was done which showed ESR 78 mm/hr, reactive RPR (1:256), positive Treponema Pallidum IgG and positive HIV 1 serology with a CD4 count of 255. Autoimmune work-up was unremarkable. The lumbar puncture was performed which showed elevated CSF protein (46 mg/dl) but
was otherwise unremarkable. He also tested positive for HBsAg, HBeAg, HBcAb (IgM), and hepatitis C antibody with a HepC viral load of 6,331,526. AST and ALT were mildly elevated. Other infectious workups for Histoplasma, Blastomyces, Toxoplasma, and IGRA were negative. He was treated with IV penicillin (24 million units daily) for 14 days total along with topical steroid and cycloplegics which improved ocular symptoms and visual acuity significantly. He was initiated on bictegravir-emtricitabine-tenofovir at the time of discharge with follow up with Infectious Disease and Ophthalmology as an outpatient. Discussion: Diagnosing syphilitic uveitis can be difficult as it lacks any pathognomonic signs. One should have a high index of suspicion in high-risk groups like men who have sex with men and HIV- positive patients. Its identification is important as it is easily treatable. It can lead to vision loss and many long-term complications if left untreated. Every patient with ocular syphilis should be tested for HIV and neurosyphilis as concurrence is high.
RENAL TUBULAR ACIDOSIS SECONDARY TO RHEUMATOID ARTHRITIS Suzanne Cooper, Ibrahim Shenawi, George Guidry; Department of Medicine, LSU Health Sciences Center, Lafayette, LA.
Introduction: Renal tubular acidosis (RTA) is an impairment in the urinary acidification mechanism that often presents as a non-anion gap metabolic
acidosis. Distal RTA, also known as type 1 RTA, is commonly associated with autoimmune disorders. The pathophysiological mechanisms are not fully
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