patient had several hospitalizations for chest pain or palpitations with chronic troponin elevations over the past two years. Extensive cardiac and non-cardiac work-up was unrevealing. Coronary Computed Tomography Angiogram revealed normal coronary arteries and cardiac calcium score of zero. Cardiac Magnetic Resonance Imaging was normal without abnormal enhancement of the myocardium to suggest myocarditis, scarring, or fibrosis. The ejection fraction (EF) was measured at 51%. Laboratory immunological workup was negative, Trypanosoma cruzi antibody negative, c-reactive protein, erythrocyte sedimentation rate, metanephrines, and cortisol, was within normal
limits. Liver and kidney function were normal. Treponemal antibody was positive with a RPR titer of 1:4 and with unknown duration of infection, he was initiated on treatment for latent syphilis. Discussion: We present this case of a healthy, young patient with a chronic troponin elevation to further advance awareness and knowledge of possible causes of troponin elevations in absence of cardiac sources. Troponin elevation may divert attention from underlying clinical problems and may lead to unnecessary cardiac evaluation, including invasive testing.
A CASE OF HEMOLYTIC ANEMIA IN THE SETTING OF CROTALID ENVENOMATION Durin Uddin MD; Department of Medicine, Ochsner Medical Center, New Orleans, LA.
Introduction: It is not very often that we encounter snake bites as a typical complaint in an average week unless rotating through the emergency department or practicing wilderness medicine. Thus, when encountered, it requires a review of the approach to snake bites and complications that can arise from envenomation. Case: A 51-year-old man with HIV/AIDS and G6PD deficiency presented after being bitten by a snake on his left hand while pulling weeds in his yard. He was initially tachycardic and afebrile with significant pain and swelling of the left hand and forearm. His initial labs were notable for a fibrinogen level <70 and CPK of 447. Medical toxicology was consulted, and he received crotalidae polyvalent immune fab (CroFab), tetanus vaccine, methylprednisolone, and diphenhydramine. He was admitted to the intensive care unit for closer monitoring. The patient’s hemoglobin decreased by five points over the first five days of his hospitalization, requiring one unit
of packed red blood cells. He had also developed frank hemoglobinuria. During this same period his fibrinogen significantly rose to the 200-300’s and subsequently trended back down with improvement of his hemoglobin. His INR was consistently normal until it peaked at 1.5. D-dimer was 3.17, haptoglobin was <10 (previously 132), and LDH was 553 in the days leading up to the patient requiring a blood transfusion. With repeated CroFab bolus and dosing over the course of two additional days after the patient had been transferred to hospital medicine, his hemoglobin and fibrinogen trended up. Discussion: This patient’s clinical course illustrates that snake bites can lead to venom- induced complications such as hemolytic anemia, coagulopathy, acute kidney injury, serum sickness, and skin necrosis and infection. Diagnostic certainty can be complicated by patient factors such as G6PD deficiency and HIV/AIDs.
UNLOCKING THE POTENTIAL: CHATGPT AND THE QUEST FOR RELIABLE BLOOD TRANSFUSION INFORMATION
Rahul Vyas MD1, Manush Sondhi MD1, Chanza Shaikh MD1, Anaiya Singh MD1, Shubhika Jain MBBS2, Aditya Vyas MD1, Michael Sewell MD1; Department of Medicine1, LSU Shreveport, Shreveport, LA, Kasturba Medical College2, Manipal, India.
Introduction: Blood transfusion, a critical medical procedure that consistently saves numerous lives, remains a cornerstone of modern healthcare. While widely employed as a therapeutic intervention, it is imperative to acknowledge its inherent risks. Patients
frequently turn to online sources for information to self-educate about blood transfusion. In these scenarios, interactive online artificial intelligence (AI) platforms like Chat Generative Pre-Trained Transformer (ChatGPT) play a revolutionary role in 30
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