with CN IX-XII palsy. Repeat imaging revealed empyema formation and SBO. Neurosurgical and otorhinolaryngology evaluated the patient but recommended medical management. She was discharged to long term acute care. Discussion: The patient presented with bilateral CST likely secondary to seeding from MSSA bacteremia and ultimately developed a subdural empyema and SBO. The incidence of CST is 0.2-1.6 per 100,000 yearly. It presents almost universally as periorbital edema. Other symptoms include blindness, CNIII-CNVI palsy, altered mentation, and Horner’s syndrome. Neuroimaging with magnetic resonance imaging or venogram should be obtained. Treatment with
antibiotics and anticoagulation is recommended, but the optimal duration is unknown. Skull base osteomyelitis is usually a result of infection in immunocompromised patients or trauma. It carries a substantial mortality rate of up to 20%. Common clinical signs include headache, cranial nerve palsies, and otalgia. Treatment includes antibiotic therapy as well as surgical debridement of infected tissue. In this case, a new CNIX palsy was suspicious for another disorder. The patient was treated with 6 weeks of antibiotics along with continued anticoagulation. Her follow-up scans completed 6 months after admission showed decreasing size of her bilateral thrombi and resolution of her subdural empyema. Her CN IX and XII palsies resolved with treatment.
ACRODERMATITIS ENTEROPATHICA AND LIVER CIRRHOSIS Sameera Shuaibi MD, Samer Farhud DO, Jenne Nguyen MD. Department of Medicine, Ochsner Medical Center, New Orleans LA
Introduction: Zinc deficiency can either be hereditary or acquired. It is often overlooked when diagnosis of skin rashes in acute hospital settings is required. Physicians tend to work up more common causes of rashes before coming to the conclusion of acrodematitis enteropathica (AE). AE a tender scaly rash can manifest also with bulla formation secondary to severe zinc deficiency. One important organ that plays a crucial role in zinc metabolism is the liver. Liver failure can interfere with zinc metabolism and manifest with its peculiar rash. Case: A 42-year-old female was admitted with decompensated alcoholic liver cirrhosis and diarrhea. Shortly after admission she developed a widespread rash that was painful, itchy, and scaly in nature with blisters. No unusual drugs were administered to her at that time that would have triggered an
allergic reaction. After dermatology was consulted and the lesions were biopsied it was found to be acrodermatitis enteropathica. She was administered high doses of zinc along with topical medications which helped improve the lesions with time. Discussion: Liver disease can predispose to zinc deficiency in such that it hinders zinc metabolism. The small intestine, pancreas, and liver play central roles in the maintenance of appropriate zinc levels in the body. Patients who develop liver disease may be at risk of experiencing sequelae of zinc deficiency such as AE. Alas, due to its sparsity, physicians may not immediately opt for the diagnosis of AE even if the patient is suffering from end stage liver disease. Such cases are pivotal in increasing physician awareness of such conditions to avoid convoluted evaluations and loss of resources before reaching the diagnosis.
CHRONIC TROPONIN ELEVATION IN A PATIENT IN ABSENCE OF IDENTIFIABLE CARDIAC PATHOLOGY Doree G. Morison, DO, MS; Kunal Gupta MD, Sunil Upadhaya, MD; George Smith, MD. Department of Medicine, Tulane University, New Orleans, LA.
Introduction: In clinical medicine, troponin is associated with cardiac pathology, and used as criteria to diagnose acute coronary syndromes. Measuring troponin is a diagnostic tool for assessing heart damage. High-sensitivity troponin (hs-ctn) have become common in practice, allowing for the detection of small amounts of troponin, aiding in early diagnosis of heart
pathology. The increased sensitivity can lead to false-positive results in non-cardiac pathology.
Case: A 27-year-old male with anxiety and hypertension presented with palpitations. Hs-ctn was 827 and 848 ng/l (normal <54 ng/l), in absence of ischemic changes on EKG or abnormalities on echocardiogram. Record review revealed the 29
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