Medicine and Health Sciences Commons^™

Jaundice With Markedly Elevated Carbohydrate Antigen 19-9 (Ca 19-9): Biliary Stones Or Malignancy?, Brianna Bourgeois

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A 59-year-old male with past medical history of untreated type 2 diabetes mellitus, hypertension, and hyperlipidemia presents to the UMC family medicine clinic for a follow up for chronic conditions after being lost to follow up for about 2.5 years. On initial observation, the patient appeared jaundiced. The jaundice is not associated with nausea, vomiting, diarrhea, or constipation. The patient does have generalized pruritus. He denied having pain in spite of questioning during the first two family medicine visits and the first visit with gastroenterology. However, on the 3rd Family Medicine visit, the patient admitted to the medical student that …

Surreptitious Diuretic Abuse In A Patient With Severe Hypokalemia And Long Qt Syndrome, Claire Carr

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Surreptitious Diuretic Abuse in a Patient with Severe Hypokalemia and Long QT Syndrome Claire Carr, MS3, LSU School of Medicine- New Orleans, Kyle Hoppens, MD, LSUHSC The patient in question was a 45 year old female with past medical history of long QT syndrome who presented to the emergency department with a chief complaint of chest pain and shortness of breath for 3 days. The patient was in her usual state of health until 3 days prior to admission, when she began experiencing a pressure-like chest pain associated with progressively worsening dyspnea. At baseline, the patient does not experience dyspnea …

Case Report: A Case Of Coccidiomycosis Confounding A Systemic Lupus Erythematosus Diagnosis, Lily Chen

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Lily Chen, Sidney Mejia, Lydia Rewers and Seema Walvekar Introduction: Systemic Lupus Erythematosis is a rare autoimmune disease with prevalence of 20-150 cases per 100,000 in the United States. Despite increased awareness among physicians and improvements in serologic testing, the time to diagnosis from symptom onset is still delayed for many patients, with one study estimating the average time to diagnosis of 6 years. One significant cause of diagnostic delay is due to the heterogeneity in the disease presentation, with symptoms that can present similarly to many other autoimmune, infectious, or hematologic diseases. Many of the symptoms of SLE are …

A Hand In Madness: Psychiatric Effects Of Lead Toxicity, Bryce Arata

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Extreme amounts of lead in the body can decouple a person’s mind from their experience of reality in the form of psychosis. While the incidence of lead-induced psychosis has declined significantly in the last several decades due to public health measures, it is a treatable cause of psychosis with an otherwise high morbidity. A 38-year-old male presents to the hospital at the request of his infectious disease physician who found the patient to have critical blood levels of lead. His past history includes ten gunshot wounds sustained at 26 years-old which resulted in a large amount of retained ballistic fragments. …

Jaundice With Markedly Elevated Carbohydrate Antigen 19-9 (Ca 19-9): Biliary Stones Or Malignancy, Brianna Bourgeois

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A 59-year-old male with past medical history of untreated type 2 diabetes mellitus, hypertension, and hyperlipidemia presents to the UMC family medicine clinic for a follow up for chronic conditions after being lost to follow up for about 2.5 years. On initial observation, the patient appeared jaundiced. The jaundice is not associated with nausea, vomiting, diarrhea, or constipation. The patient does have generalized pruritus. He denied having pain in spite of questioning during the first two family medicine visits and the first visit with gastroenterology. However, on the 3rd Family Medicine visit, the patient admitted to the medical student that …

A Case Of Recurrent Head And Neck Dermatofibrosarcoma Protuberans, Kathryn Dillman

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Title: A Case of Recurrent Head and Neck Dermatofibrosarcoma Protuberans Authors and Affiliations: Kathryn Dillman, BS; Nicholas Culotta, MD; Christopher Haas, MD; LSU School of Medicine New Orleans and LSU Department of Dermatology Patient Initials: DF History of Present Illness: Personal Data: 68 y.o. M Patient is a 68-year-old male with a history of dermatofibrosarcoma protuberans (DFSP) of the left cheek who presented to dermatology clinic for follow-up skin exam. He noted a few concerning lesions on the trunk and the face that he would like examined, but denied any bleeding, ulceration, enlarging, or non-healing lesions. He initially reports a …

An Ironic Electrolyte Imbalance: A Hyperkalemic Emergency In Primary Hyperaldosteronism, Amded-Fazal-Ur Rehman

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Title: An Ironic Electrolyte Imbalance: A Hyperkalemic Emergency in Primary Hyperaldosteronism Ahmed Fazul-ur-rehman, Asad Mussarat MD, Luke Yesbeck DO, Angus Harper MD, Ashley Van MD, Sumrita Bindra DO, Rebecca Maitski, Brian Mackel MD, Seth Vignes, MD Department of Internal Medicine, LSU Health Sciences Center Introduction: Hyperkalemia is a common medical emergency that can lead to life-threatening complications, including muscle weakness, paralysis, and worst arrhythmias due to cardiac membrane instability. Primary hyperaldosteronism is a disorder where excess aldosteronism promote intravascular volume expansion and renal loss of serum potassium. When treated, however, patients’ electrolyte imbalance overcompensates and can presents with hyperkalemia. We …

Aseptic Meningitis As The Sole Symptom Of Legionnaire’S Disease, Michael Forte

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Aseptic Meningitis as the Sole Symptom of Legionnaire’s Disease • Michael Forte (LSU HSC School of Medicine) mfort1@lsuhsc.edu • William Benton, M.D. (LSU HSC Department of Internal Medicine, Baton Rouge) wbento@lsuhsc.edu CASE PRESENTATION A 41-year-old incarcerated male with a history of migraines and prior tobacco use presented in late summer with fevers, headaches, neck stiffness, and body aches for four days. He was sent to the ED for further evaluation after recording a temperature of 104° at the prison’s infirmary. On evaluation in the ED, his temperature was 99.5°F, and his heart rate was 105 bpm. He was diaphoretic, and …

Gabapentin To Cyclobenzaprine: A Case Of Acute Reversible Iatrogenic Psychosis Influenced By Schedule V Classifications, Grant Collins

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Clinical guidelines within psychiatric therapeutics continuously evolve, leading to varying exposure of specific population subgroups to particular therapeutic classes of medication. Such shifts are crucial, as these subgroups might be more susceptible to adverse reactions not common in the broader population. One pertinent example of this occurrence is the classification of Gabapentin as a Schedule V drug such as in Kentucky; which will likely lead to increased prescription rates of alternatives such as cyclobenzaprine (Flexeril®) in subgroups prone to recreational drug use. We present a case of a young incarcerated individual who developed acute mania after switching from gabapentin to …

Chronic Osteomyelitis Predictors With Pattern Of Care And Health Services, Thuc Truong

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Background: Chronic osteomyelitis is an infection of the bone presenting at a point in time after an acute injury or trauma. The infection may occur due to a multitude of reasons, but a couple would be open wounds or biofilms created by pathogens on implanted hardware. Commensal staphylococci are the most common cause of osteomyelitis1 . Management of chronic osteomyelitis can either be surgical with irrigation and debridement, a course of antibiotics ranging from four to six weeks, or a combination of both2 . Chronic osteomyelitis can complicate the healing process, but also place a burden on the patient if …

An Atypical Case Of Sweet Syndrome, Samuel Halle

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Title: An Atypical Case of Sweet Syndrome

Authors and Affiliations: Samuel Halle, LSU School of Medicine MD Candidate; Michael Olejniczak, LSUNO Comprehensive Medicine House Officer; Mohammed Ziada, LSUNO Assistant Professor; Daniel Provenzano, LSUNO Anesthesiology; Peyton Hopkins, LSUNO Comprehensive Medicine

Case Presentation: A 68-year-old female with a PMH of progressive CKD5, and Type II Diabetes Mellitus bounces back to the UMC ED with blurry vision, ocular disturbances, abdominal pain, and progressive weakness. Things have just been getting worse for her. Two days ago she was discharged with a large conjunctival mass with instructions to seek treatment at an Ophthalmology center, but …

Vaping-Related Pneumomediastinum In The Younger Patient Population, Andrew Hoang

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Title: Vaping-related pneumomediastinum in the younger patient population Authors: Andrew Hoang BS, Arash Ataei MD, Paul Videau MD, Michael Olejniczak MD, Victoria Lulich MD, Hunner Luke MD, Briggs Welch MD, Taylor Sanders MD, Najy Masri MD

Introduction: Herein, we describe a case of a young patient presenting with pneumomediastinum (PM) associated with vaping use. PM is due to air leaking within the mediastinal tissues that can travel to associated structures, often classified as spontaneous or traumatic. PM is an uncommon complication of asthma and often presents with acute chest pain or shortness of breath.1 While relatively rare, it is more …

A Case Of Malignant Melanoma In A Fitzpatrick Type Iii Male Patient, Lisa Kam

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Title: A Case of Malignant Melanoma in a Fitzpatrick Type III Male Patient

Authors and Affiliations: Dr. Deborah C. Hilton, MD, LSUHSC New Orleans; Lisa Kam, BS, MS, LSUHSC New Orleans.

Case Presentation: We present a 36-year old African American patient with a slow growing lesion on his left ear since he was 10 years old. The patient denied symptoms of fever, chills, nausea, vomiting, weight loss, and myalgias. He stated that the lesion was “burned off” in childhood, and observed recurrence of the nodule two years before visiting our clinic. The lesion measured 9mm in diameter upon presentation. Tangential …

Multifocal Pneumonia With Complications Secondary To Aspiration Of Rare Anaerobe, Emma James

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MULTIFOCAL PNEUMONIA WITH COMPLICATIONS SECONDARY TO ASPIRATION OF RARE ANAEROBE

Emma James, BS, Keyur Patel, MD, Michael Brands, MD, Nali Gillespie, MD, Chantal Wickman, MD, Kyle Hoppens, MD, Jorge Martinez, MD Department of Medicine, LSUHSC, New Orleans, LA

Introduction: In the United States, pneumonia is the most common infectious cause of death and the second most common cause of hospitalizations. Factors such as age, comorbidities, infections, and smoking can predispose individuals to getting pneumonia. This case presents an unusual case of severe pneumonia in an individual with no known risk factors. Case Description: A 42-year-old-male with no past medical history …

Rare Adverse Reaction To Nexplanon, Breyanah Graham

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Title: Rare adverse reaction to Nexplanon

Authors and affiliations: Breyanah Graham1, Rachel Denneny2 MD, Nicole Freehill2 MD MPH 1LSU Health Sciences Center, School of Medicine, New Orleans, LA 2LSU Health Sciences Center, Department of Obstetrics and Gynecology, New Orleans, LA

Case Presentation: A 23 y.o. G1P1001 with a past medical history of stage 1A mucinous borderline ovarian tumor presented in clinic for removal of her Nexplanon implant site 42 days after standard placement due to concerns for possible reaction or infection. The patient reported that the site where Nexplanon was placed never healed, and she had noticed escalating pain and …

Glp-1 Agonists And Gastroparesis: Ozempic Initiation In A Case Of Chronic Gi Issues, Landon Krone

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GLP-1 Agonists and Gastroparesis: Ozempic Initiation in a Case of Chronic GI Issues

Landon Krone, BS; Lara Boudreaux, MD; Catherine Hudson, MD Louisiana State University Section of Gastroenterology

Gastroparesis is a chronic disorder involving delayed emptying of the stomach after a meal. Symptoms include nausea, vomiting, belching, bloating, and early satiety. Glucagon-like peptide-1 (GLP-1) receptor agonists function like the incretin hormone GLP-1 that is released into the intestine after consumption of food. GLP-1 agonists can serve as pharmacologic agents to treat type 2 diabetes, as they increase insulin sensitivity, decrease glucagon secretion, and slow gastric emptying. At this time, there …

Calciphylaxis: An Unusual Course Of A Rare Condition, Michelle Livitz

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Calciphylaxis: an unusual course of a rare condition

Michelle Livitz, Maren Bell, Mohammed Ziada Department of Internal Medicine, LSU Health Sciences Center, New Orleans, Louisiana

INTRODUCTION Calciphylaxis is a rare disorder, mostly seen in those with End-Stage Renal Disease (ESRD). It is characterized as calcification of arterioles and capillaries in the dermis and subcutaneous adipose tissue, leading to local ischemia and necrosis of the affected tissue. It is associated with a high mortality and morbidity with no definitive treatment or cure. CASE 35 y/o F with history of ESRD on hemodialysis (HD), HTN, STEMI s/p DES, and Mitral Valve Replacement …

Anaphylactic Reaction To Chlorhexidine After Plantar Fasciitis Injection, Chad Hobbs

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Anaphylactic Reaction to Chlorhexidine After Plantar Fasciitis Injection

Brandon M. Savage, M.D., Casey A. Murphy, M.D., F.A.A.P.M.R., D.A.A.P.M, Chad Hobbs, D.O., DPT LSU PM&R and VA Medical Center of New Orleans

We performed a chart review and patient interview. A 48-year-old male presented to his podiatrist’s clinic for a therapeutic injection into his foot to manage plantar fasciitis. The patient had no known allergies to medications or topical agents and had no history of adverse reactions during previous medical procedures. Prior to injection, chlorohexidine with alcohol was used at the injection site as part of routine preparation. A mixture containing …

Milk-Alkali Syndrome, An Udder Failure Of Acid Control, Michelle Livitz

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Milk-Alkali syndrome, an udder failure of acid control

Michelle Livitz DO, Asad Mussarat MD, William Gibson MD, Daniel Holmes MD Department of Internal Medicine, Louisiana State University- New Orleans

Introduction: Milk-Alkali syndrome is characterized by a triad of lab findings: elevated calcium levels, metabolic alkalosis, and acute kidney injury. This is found in the setting of substantial intake of calcium and an absorbable alkali. It now accounts for more than 10% of hypercalcemia cases and is the third most common cause of hypercalcemia in hospitalized patients, after hyperparathyroidism and malignancy. In Milk-Alkali syndrome, the hypercalcemia is caused due to the …

A Splenic Surprise: Navigating Littoral Cell Angioma In An Elderly Patient, Ryan Kreider

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A Splenic Surprise: Navigating Littoral Cell Angioma in an Elderly Patient

Ryan Kreider, Asad Mussarat, MD; Nikki Arceneaux, MD, Kirandeep Chahal, MD Department of Internal Medicine, LSU Health Science Center New Orleans

Introduction: Littoral Cell Angioma (LCA) is a rare primary vascular tumor of the spleen. Typically, LCAs are incidentally found as a single or multiple benign tumor(s) appearing among the littoral cells which line the venous sinuses of splenic red pulp. While less common, there are also reported cases of malignant subtypes of LCAs. We present a case who was admitted out of concern for intra-abdominal hemorrhage, later finding …

Membranoproliferative Glomerulonephritis In Primary Sjogren’S Syndrome, Michelle Livitz, Maria Rodrigues

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Membranoproliferative Glomerulonephritis in primary Sjogren’s Syndrome

Michelle Livitz DO1 , Maria Rodriguez DO1 , Nahida Baigam MD2 , Farshid Yazdi MD2 1. Department of Internal Medicine, LSUHSC- NO, 2. Department of Nephrology, LSUHSC-NO

Introduction: Primary Sjogren’s syndrome (pSS) is an autoimmune disease that causes lacrimal and salivary gland dysfunction via lymphocytic infiltration, resulting in xerophthalmia and xerostomia. Extraglandular features can be exhibited, including renal involvement, which is noted in only 5% of pSS patients. The most common histological pattern of renal disease in pSS is tubulointerstitial nephritis, while glomerular disease in these patients is uncommon. Of the glomerular diseases that …

Macrofocal Multiple Myeloma: A Special Subgroup Of Multiple Myeloma, Catherine Loehr

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Case Report: A 45-year-old Honduran man with no prior medical history presented to clinic for left-sided rib pain radiating to his back. Pain first began after falling off a truck onto his back 6 years ago, previously relieved with pain medicine. However, he recently moved to the US and ran out of medicine. Spine x-ray showed compression fracture at T10-T11. Biopsy was performed at a T11 lytic lesion showing plasma cell neoplasm with no involvement in the bone marrow. There was successful treatment with focal radiation to the spine, thus no indication for chemotherapy or surgery. PET scan noted a …

Simultaneous Diagnosis Of Hiv And Disseminated Kaposi Sarcoma, Catherine Loehr

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Case Report: A 26-year-old man with newly diagnosed HIV (on Biktarvy, recent undetected viral load, CD4 496) complicated by Kaposi Sarcoma (KS) presented to the ED for gradual severe left lower extremity (LLE) pain and edema radiating to his groin onset 2 weeks prior. Also complained of subjective fever, chills and night sweats. He had a previous episode of generalized swelling 7 months prior when his oropharyngeal mass was biopsied and found to be HIV positive with KS. He was initiated on antiretroviral therapy with Biktarvy and referred to oncology for KS management where he completed six cycles of Doxorubicin …

A Case Of Symptomatic Tachyarrhythmia Of Unkown Etiology, Collen Leslie

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A Case of Symptomatic Tachyarrhythmia of Unknown Etiology

Coleen Leslie, Michael Olejniczak MD, Ilija Zecevic MD, Alex Glaser MD; Department of Medicine, LSU Health Sciences Center, New Orleans, LA.

Case: A 42-year-old African American female with a relevant past medical history of essential hypertension, pre-diabetes, and polycystic ovarian syndrome presented with new onset chest pain upon exertion. The first episode of symptoms occurred while the patient was performing her regular duties as a housekeeping manager when she suddenly experienced palpitations, diaphoresis, and an overall sense of warmth that dissipated with rest. A little less than one week later, the patient …

Methotrexate Toxicity Induced Pancytopenia And Oral Ulcerations, Brooke Mcvaney, Salim Lutfalla

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Authors: Brooke McVaney, DO; Salim Lutfallah, MS3; Ashley Misky, DO; Najy Masri, MD Louisiana State University Internal Medicine, New Orleans, LA

Case: A 65-year-old male presented to the emergency department with painful oral ulcerations for 10 days and a generalized rash for 6 days. His medical history was significant for coronary artery disease, seropositive rheumatoid arthritis on MTX, and paroxysmal atrial fibrillation. Vital signs were within normal limits upon presentation. On exam he was noted to have scattered petechiae with central erosions and excoriations to the bilateral upper and lower extremities, palms, back and trunk. He had oral mucosal lesions …

Cryptogenic Pyogenic Liver Abscess Due To Parvimonas Micra And Fusobacterium Nucleatum, Hope Otto Moise, Allen Byl

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Cryptogenic Pyogenic Liver Abscess due to Parvimonas micra and Fusobacterium nucleatum

Authors and Affiliates: Allen Byl, DO, Hope Oddo Moise, MD, Danielle Gilbert, DO, Nataliya Khimitch, MD, Paul Videau, MD, Victoria Burke, MD

Case: A 30-year-old male presented with fevers, chills, body aches, and abdominal pain for 7 days. He had a medical history of obesity and alcohol use. He reported abdominal pain as colicky in nature and associated with nausea, persistent non-bloody and non-bilious vomiting. At the time of hospital admission, he was afebrile but tachycardic with a heart rate of 122 BPM. His physical exam was significant for …

Leptospirosis: An Uncommon Cause Of Fever And Transaminitis In The Continental United States, Hope Otto Moise, Allen Byl

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Leptospirosis: An Uncommon Cause of Fever and Transaminitis in the Continental United States

Authors and Affiliates: Allen Byl, DO; Hope Oddo Moise, MD; Danielle Gilbert, DO, MPH; Michael Olejniczak, MD; Ashley Misky, DO; Tom Fox, MD; Alexa Lapointe, MD; Michael Modica, MD; Michelle Blyth, MD.

Case: A 24-year-old man presented with fevers, rigors, body aches, and headache for 6 days. He had recently returned from a 2-week trip to Colombia, during which time he went white water rafting, drank filtered stream water, had prolonged insect exposure with bites, and ate locally prepared food, including various meats. No one else from …

Sinister Sinusitis: Unraveling The Myserty Of Subgaleal Abscess, Salim Lutfallah

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No abstract provided.

Pyogenic Liver Abscess As A Late Complication Of Hernia Repair, Carter Pesson

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Pyogenic liver abscess as a late complication of hernia repair

• Carter Pesson, MD, MPH (LSUHSC) < cpesso@lsuhsc.edu > • Sidney Mejia, MD, MPH (LSUHSC) < smeji1@lsuhsc.edu > • Sanjay Kamboj, MD (LSUHSC) < skambo@lsuhsc.edu >

Clinical Vignette: An 81-year-old male with a past medical history significant for thoracic aortic aneurysm, HTN, enucleated right eye, and incarcerated inguinal hernia status post repair presented to the emergency department with progressive weakness associated with subjective fever, chills, and unintentional weight loss. On exam, he had epigastric abdominal tenderness overlying a palpable, immobile mass measuring approximately 3 cm, circumscribed with visible vasculature surrounding the tissue, along with 1+ pitting edema to bilateral …

Marantic Endocarditis In Antiphospholipid Syndrome: An Incidental Discovery Leading To Aortic Valve Replacement, Sepehr Sadgeghi

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Marantic endocarditis in antiphospholipid syndrome: An incidental discovery leading to aortic valve replacement.

Sepehr Sadeghi, DO. Department of Medicine, LSU Health Sciences Center, New Orleans, LA.

Case Presentation: A 60-year-old female with a past medical history of left popliteal DVT, APS, pulmonary embolism with open embolectomy, and ischemic stroke presented to the hospital after being referred by her cardiologist after a large mobile aortic valvular vegetation was noted on a routine TTE. On presentation, patient was asymptomatic with unremarkable vital signs. Physical exam showed cyanosis and mottling in the left lower extremity, of which a venous doppler US was negative. …