AN INTERESTING CASE OF GRAM-NEGATIVE BACTEREMIA DUE TO SUPERIOR MESENTERIC VEIN (SMV) THROMBOSIS Anisha Memdani MD, Bharatsimha Toutireddy MD, Todd Hollingsworth MD, Amir Ausef MD; Department of Medicine, Baton Rouge General Medical Center, Baton Rouge, LA.
Introduction: Symptoms of Superior Mesenteric Vein (SMV) thrombosis vary widely depending on the chronicity of the condition. Acute SMV thrombosis presents with severe abdominal pain, cramps, nausea, and vomiting. Examination findings usually have abdominal tenderness and distension. Case: A 54-year-old male who presented to with a two-week history of fevers and rigors was asked to go to the hospital as his blood cultures grew gram-negative bacteria. On presentation, he had a fever without any cough, dysuria, abdominal pain, arthralgia, rash, nausea, vomiting, or diarrhea. No recent travel was reported. On further questioning, the patient revealed that he had severe abdominal pain with an episode of vomiting at the onset of his symptoms before having fever two weeks ago. Abdominal pain was short in duration and only lasted a few hours. His exam on presentation was fairly benign. Abdominal Computed Tomography revealed an acute SMV thrombosis. He was started on Cefepime and therapeutic Enoxaparin and had a series of abdominal exams. The patient felt better after two days, as his fever subsided, he requested discharge home despite knowing the
risk. He was discharged home on Apixaban and oral antibiotics. Considering SMV thrombosis is secondary to hypercoagulable state, malignancy, inflammatory bowel disease or previous surgery, he was asked to follow up with his PCP. Plans for further investigations included a hypercoagulable workup, including cancer screening, and colonoscopy to be done as an outpatient per patient preference. Upon follow-up, blood cultures from his PCP’s office grew Bacteroides Fragilis. Discussion: Mortality for SMV thrombosis is reported as high as 23% due to transmural infarction and translocation of gut bacteria such as B. Fragilis. Untreated B. Fragilis bacteremia carries a high mortality rate. Mortality also remains high due to insufficient clinical awareness of the variable disease presentation leading to a delay in diagnosis. Our case illustrates an atypical presentation of acute SMV thrombosis with bacteremia without any significant abdominal signs on presentation. Through this case, we aim to shed light on the spectrum of disease presentation and the need for further workup in patients with SMV thrombosis.
DUAL DIAGNOSIS DILEMMA: KIKUCHI-FUJIMOTO DISEASE AND SYSTEMIC LUPUS ERYTHEMATOSUS Meghana Kasula MD, Shiva Charan Anaji MD, Guru Prasad Parthiban MD, Tanmayi Gadre MD, Aaron Williams MD; Department of Medicine, Baton Rouge General Medical Center, Baton Rouge, LA.
Introduction: Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a rare benign self-limiting condition of unknown etiology, characterized by cervical lymphadenopathy and fever. Clinical presentation of KFD is non-specific and can often mimic infections (mononucleosis, tuberculosis, cat scratch disease), lymphoma, or metastatic cancer. Moreover, KFD has been reported in conjunction with systemic lupus erythematosus (SLE), and distinguishing KFD lymphadenopathy from SLE-associated adenitis can be challenging. Our case emphasizes this intriguing association, underscoring the importance of prompt lymph node biopsy to prevent misdiagnosis and inappropriate treatment.
with a 2-month history of progressively worsening bilateral leg weakness, urinary incontinence, and unintentional weight loss. Computed Tomgraphy of the head and cervical spine and Magnetic Resonance Imaging of the cervical, thoracic, and lumbar spine were unremarkable except for the demonstration of right cervical and internal jugular chain lymphadenopathy. Cerebrospinal fluid analysis was consistent with aseptic meningitis. Meanwhile, the patient began to spike fevers up to 101oF, with elevated inflammatory markers and pancytopenia. A thorough infectious and autoimmune workup was initiated that returned positive for ANA (1:160 speckled pattern), anti-Smith, and anti-RNP, which
was concerning for SLE. A cervical lymph node biopsy was obtained that showed necrotizing 44
Case: A 28-year-old male with depression presented
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