C linical C ase of the M onth
Abstracts From the Louisiana American College of Physicians Associates Meeting
Each year medical students in Louisiana and residents from the eight Internal Medicine training programs in Louisiana are invited to submit abstracts for the annual Louisiana American College of Physicians (ACP) Associates Meeting. 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 to physician judges. Each judge scores each abstract independently, and the scores from the judges are averaged and ranked. This year we are excited to be able to publish the 26 most highly ranked abstracts presented at this year’s competition. These abstracts (15 oral, 11 poster) were presented at the Associates Meeting held at the Louisiana State University Health Sciences Center in Shreveport on January 21, 2014. We would like to thank the Journal of the Louisiana State Medical Society and appreciate its efforts to publicize the hard work of these trainees.
Lee S. Engel, MD, PhD, FACP Chair, Louisiana Associates Liaison Committee
William Davis, MD, FACP Governor, Louisiana Chapter ACP
A Case of Mixed Pulmonary Infection With Two Non-TuberculousMycobacteriumSpecies in a Previously Health Adult Male Y. Nikitina, A. Bapat, and B. Nseir Department of Internal Medicine University Medical Center, LSU-Health Sciences Center, Lafayette Case: A 41-year-old previously healthy African-Ameri- can man presented with shortness of breath and productive cough. Chest radiograph and chest CT identified a diffuse nodular infiltrate with a large cavitary lesion and a large pneumothorax in the right hemithorax with additional cavitary lesions in the left upper lobe. A sputum culture was positive for a Mycobacterium kansasii, and the patient was subsequently started on isoniazid 300 mg, rifampin 600 mg, and ethambutol 600 mg. The M. kansasii susceptibility testing revealed resistance to ciprofloxacin, rifampin, and trimethoprim-sulfamethoxazole. Unfortunately, no follow- up sputum cultures were collected, but the patient reported completing a 15-month course of treatment. Three months later, he presented to the emergency room with chest pain and shortness of breath with a productive cough for two- month duration. Chest radiograph identified bilateral, up- per lobe bullous emphysematous changes with probable superimposed atypical infection of the left upper lobe. Blood-tinged sputumwas noted on presentation. The cytol-
ogy and culture of bronchial endoscopy washings revealed Mycobacterium Avium Complex. The azithromycin and moxifloxacin regimen was initiated. Discussion: Most cases of atypical mycobacteriosis are secondary infections associated with underlying lung disease and immunosuppression secondary to HIV/AIDS or malignancy. In this patient, however, we report an un- usual case of pulmonary infection due to M. kansasii and M. Avium Complex in an otherwise healthy male without underlying lung disease. Isolated Small Intestinal Metastatic Disease as a Herald of Recurrent NSCLC E. Miller, C. Caruthers, and S. Sanne LSU-Health Sciences Center, New Orleans Introduction: The small bowel is a very rare location of metastatic deposits of non-small cell lung cancer (NSCLC). Case: A 58-year-old patient with a history of Stage III (T2N2M0) NSCLC treated with chemotherapy and radia- tion presented to the hospital with one week of shortness of breath and chest discomfort. The patient’s NSCLC had been considered to be in virtual remission based on a PET scan following his treatment. At presentation, the patient was found to have a severe microcytic anemia. Initial workup for a source for the patient’s blood loss was negative. A re- view of the patient’s medical record suggested a suspicious
J La State Med Soc VOL 166 March/April 2014 81
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