JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Abstracts from the 2017 Annual Louisiana American College of Physicians (ACP) Associates Meeting
Each yearmedical students in Louisiana and residents fromthe eight Internal Medicine trainingprograms in Louisiana are invited to submit abstracts for theAnnual LouisianaAmericanCollege of Physicians (ACP) AssociatesMeeting. The content of these abstracts includes clinical case vignettes or research activities. The abstracts have all identifying features removed (i.e., names, institutional affiliations, etc.) before being sent tophysician judges. Each judge scores eachabstract independently and then the scores fromall judges are averagedand ranked. This year we are excited to be able to publish the 28 most highly ranked abstracts presented at this year’s competition. These abstracts (15 oral; 13 poster) were presented at the Associates Meeting held at Ochsner Medical Center in New Orleans on January 24, 2017. We would like to thank the Journal of the Louisiana StateMedical Society and appreciate its efforts to publish the hardwork of these trainees.
Shane Sanne, DO Chair, Louisiana Associates Liaison Committee
Lee S. Engel, MD, PhD, FACP Governor, Louisiana Chapter ACP
DELAYED PRESENTATION OF TUBEROUS SCLEROSIS COMPLEX IN AN ADULT WOMAN J. Manalac, MD; S. Saad, MD; G. Akoghlanian, MD; T. Benoit-Clark, MD. Department of Internal Medicine, University Hospital and Clinics, LSU Health, Lafayette Introduction: Tuberous sclerosis complex (TSC) is an autosomal dominant disorder character ized by the format ion of hamartomatous lesions inmultiple organs, with a birth incidence of around one in 10,000. Although it usually manifests itself in early life, we present a case of an adult womanwhowe diagnosed with TSC. Case: A 27 year oldwoman presented to Emergency Department with worsening right flank pain and progressive dyspnea. Physical examination findings revealed Shagreen patches and multiple angiomyolipomas of the skin. Computed tomography scan of the chest and abdomen was remarkable for pulmonary lymphangioleiomyomatosis and renal angiomyolipomas. Brain imaging revealed multiple subependymal nodules and cortical dysplasias. Subsequent genetic testing later confirmed pathogenic mutation in the TSC2 gene and patient was referred for Genetic counseling and further management. Discussion: Clinical features of TSC continue to be the principal means of diagnosis, with the inclusion of identification of a pathogenic mutation in TSC1 and TSC2 as an independent diagnostic criterion. Affected patients may present early in life with the classic triad of seizures, intellectual disability, and cutaneous angiofibromas, but some findings, notably renal angiomyolipomas and pulmonary lymphangioleiomyomatosis (LAM), emerge later, placing adults with undiagnosed TSC at increased risk for morbidity and mortality. Recent advances in the treatment of TSC highlight the need to identify and follow affected patients.
WEIL’S DISEASE FROM A LOCAL NEW ORLEANS BAR
H.P. Kahn, MD; L. Bateman, MD Department of Medicine, Ochsner Clinic Foundation, New Orleans, LA
Introduction: Leptospirosis is a zoonotic infection that typically presents with fever, myalgias, nausea, and vomiting after contact with contaminated waters or infected animals (typically rodents) and their excrements. Conditions favorable to the transmission of leptospirosis are common in LA and, without treatment, leptospirosis can lead to both liver and renal failure, meningitis, pulmonary hemorrhage and ultimately death. Case: A 56 year oldwomanwith no pastmedical history presented to the Emergency Department withweakness, myalgias, jaundice anddecreasedurine output for oneweek. On arrival, she appeared septic with a heart rate of 130 and fever. Her examwas significant for significant jaundice and diffuse abdominal pain. Laboratory studies were notable for WBC 14, hemoglobin of 12 and platelet count of 63. Creatinine was 8.5mg/dL with a blood-urea nitrogen of 96mg/dl. Total bilirubinwas 19.4mg/dL and direct bilirubinwas 13.7mg/dL. AST/ALTwere 69/38 U/L, respectively and the alkaline phosphate was 160U/L. The patient was admitted to the hospital medicine wards for sepsis and multi-organ failure. She was started on broad spectrum antibiotics but her clinical condition continued toworsenwith progressive decline in her hemoglobin and thrombocytopenia and worsening liver failure. She quickly became anuric necessitating dialysis and developed respiratory distress with bilateral pulmonary infiltrates and hemoptysis. Additional historywas obtained fromher employer that sheworks at a local New Orleans bar and had been cleaning out rats from the kitchen. Leptospirosis antibody was sent, which returned as positive. Her antibiotics were de-escalated to IV Ceftriaxone. She made a slow recovery over the next two-week period.
Discussion: Since 1987, there has been an average of 3 cases of
46 J La State Med Soc VOL 169 MARCH/APRIL 2017
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