Medicine and Health Sciences Commons^™

Antitumor Activity Of 2,9-Di-Sec-Butyl-1,10-Phenanthroline, Dongsheng Wang, Shifang Peng, Arm R. Amin, Mohammad Aminur Rahman, Sreenivas Nannapaneni, Yuan Liu, Dong M. Shin, Nabil F. Saba, Jack F. Eichler, Zhuo G. Chen

Pharmaceutical Science and Research

The anti-tumor effect of a chelating phen-based ligand 2,9-di-sec-butyl-1,10-phenanthroline (dsBPT) and its combination with cisplatin were examined in both lung and head and neck cancer cell lines and xenograft animal models in this study. The effects of this agent on cell cycle and apoptosis were investigated. Protein markers relevant to these mechanisms were also assessed. We found that the inhibitory effect of dsBPT on lung and head and neck cancer cell growth (IC50 ranged between 0.1–0.2 μM) was 10 times greater than that on normal epithelial cells. dsBPT alone induced autophagy, G1 cell cycle arrest, and apoptosis. Our in vivo …

Multipoint Genome-Wide Linkage Scan For Nonword Repetition In A Multigenerational Family Further Supports Chromosome 13q As A Locus For Verbal Trait Disorders, D. T. Truong, L. D. Shriberg, S. D. Smith, K. L. Chapman, A. R. Scheer-Cohen, M. M.C. Demille, A. K. Adams, Alejandro Q. Nato Jr., E. M. Wijsman, J. D. Eicher, J. R. Gruen

Biochemistry and Microbiology

Verbal trait disorders encompass a wide range of conditions and are marked by deficits in five domains that impair a person’s ability to communicate: speech, language, reading, spelling, and writing. Nonword repetition is a robust endophenotype for verbal trait disorders that is sensitive to cognitive processes critical to verbal development, including auditory processing, phonological working memory, and motor planning and programming. In the present study, we present a six-generation extended pedigree with a history of verbal trait disorders. Using genome-wide multipoint variance component linkage analysis of nonword repetition, we identified a region spanning chromosome 13q14–q21 with LOD = 4.45 between …

Baylisascaris Procyonis Exposure Case Study, Andrea M. Lauffer M.D., Patricia Lutz M.D., Susan L. Flesher M.D.

Pediatrics

We report a case of exposure to raccoon feces found to be contaminated with baylisascaris procyonis. The exposure was recognized early enough by the family to allow prophylaxis with albendazole. Because of the potential fatal or neurologically catastrophic effects of this disease immediate treatment is indicated. This is started in advance of environmental studies that are done to determine if the feces is indeed contaminated.

Glutathione Species And Metabolomic Prints In Subjects With Liver Disease As Biological Markers For The Detection Of Hepatocellular Carcinoma, Juan R. Sanabria, Rajan S. Kombu, Guo-Fang Zhang, Yana Sandlers, Jizhou Ai, Rafael A. Ibarra, Rime Abbas, Kush Goyal, Henri Brunengraber

Surgery

Background: The incidence of liver disease is increasing in USA. Animal models had shown glutathione species in plasma reflects liver glutathione state and it could be a surrogate for the detection of hepatocellular carcinoma (HCC).

Methods: The present study aimed to translate methods to the human and to explore the role of glutathione/metabolic prints in the progression of liver dysfunction and in the detection of HCC. Treated plasma from healthy subjects (n = 20), patients with liver disease (ESLD, n = 99) and patients after transplantation (LTx, n = 7) were analyzed by GC- or LC/MS. Glutathione labeling profile was …

Epoxyeicosatrienoic Acids Regulate Adipocyte Differentiation Of Mouse 3t3 Cells, Via Pgc-1Α Activation, Which Is Required For Ho-1 Expression And Increased Mitochondrial Function, Maayan Waldman, Lars Bellner, Luca Vanella, Joseph Schragenheim, Komal Sodhi, Shailendra P. Singh, Daohong Lin, Anand Lakhkar, Jiangwei Li, Edith Hochhauser, Michael Arad, Zbigniew Darzynkiewicz, Attallah Kappas, Nader G. Abraham

Biochemistry and Microbiology

Epoxyeicosatrienoic acid (EET) contributes to browning of white adipose stem cells to ameliorate obesity/diabetes and insulin resistance. In the current study, we show that EET altered preadipocyte function, enhanced peroxisome proliferation-activated receptor γ coactivator α (PGC-1α) expression, and increased mitochondrial function in the 3T3-L1 preadipocyte subjected to adipogenesis. Cells treated with EET resulted in an increase, P < 0.05, in PGC-1α and a decrease in mitochondria-derived ROS (MitoSox), P < 0.05. The EET increase in heme oxygenase-1 (HO-1) levels is dependent on activation of PGC-1α as cells deficient in PGC-1α (PGC-1α knockout adipocyte cell) have an impaired ability to express HO-1, P < 0.02. Additionally, adipocytes treated with EET exhibited an increase in mitochondrial superoxide dismutase (SOD) in a PGC-1α-dependent manner, P < 0.05. The increase in PGC-1α was associated with an increase in β-catenin, P < 0.05, adiponectin expression, P < 0.05, and lipid accumulation, P < 0.02. EET decreased heme levels and mitochondria-derived ROS (MitoSox), P < 0.05, compared to adipocytes that were untreated. EET also decreased mesoderm-specific transcript (MEST) mRNA and protein levels (P < 0.05). Adipocyte secretion of EET act in an autocrine/paracrine manner to increase PGC-1α is required for activation of HO-1 expression. This is the first study to dissect the mechanism by which the antiadipogenic and anti-inflammatory lipid, EET, induces the PGC-1α signaling cascade and reprograms the adipocyte phenotype by regulating mitochondrial function and HO-1 expression, leading to an increase in healthy, that is, small, adipocytes and a decrease in adipocyte enlargement and terminal differentiation. This is manifested by an increase in mitochondrial function and an increase in the canonical Wnt signaling cascade during adipocyte proliferation and terminal differentiation.

Continuing Development Of An All Payer Health Care System In Maryland, David P. Paul Iii, Taeko Matsumoto, Alberto Coustasse, Lama Mohammed Bakhamis, Mary Lynn Harshbarger

Management Faculty Research

The state of Maryland, in collaboration with the Centers for Medicare and Medicaid, developed the first all-payer system model in the U.S. in 1971, and some 35 years later in response to financial pressures, modernized this program. The focus of the modernized program was to improve overall per capita expenditure, quality of care, and the outcome of Marylanders’ health.

This study showed positive change in moving its healthcare delivery model from volume-driven care to value-driven coordinated care. Maryland hospitals have changed their mindsets to achieve the Triple Aim of cost reduction, health improvement, and quality of care improvement for the …

A Rare Case Report Of Spontaneous Resolution Of Hepatic Portal Venous Gas Associated With Cocaine‑Induced Intestinal Ischemia, H. Patel, H. Shaaban, Nihar Shah Md, W. Baddoura

Gastroenterology

Hepatic portal venous gas (HPVG) is a rare disease entity. It is an ominous finding, usually, associated with intraabdominal ischemic necrosis. It frequently requires emergent surgical intervention. Herein, we present a case of a patient who complained of intense abdominal pain, with radiographic findings of HPVG as a result of cocaine-induced vascular insufficiency. After 5 h of nonoperative and conservative management, the HPVG spontaneously resolved. The patient clinically improved and was discharged home in a stable condition.

Attenuation Of Na/K-Atpase Mediated Oxidant Amplification With Pnaktide Ameliorates Experimental Uremic Cardiomyopathy, Jiang Liu, Jiang Tian, Muhammad Chaudhry, Kyle Maxwell, Yanling Yan, Xiaoliang Wang, Preeya T. Shah, Asad A. Khawaja, Rebecca Martin, Tylor J. Robinette, Adee El-Hamdani, Michael W. Dodrill, Komal Sodhi, Christopher A. Drummond, Steven T. Haller, David J. Keenedy, Nader G. Abraham, Zijian Xie, Joseph I. Shapiro Md

Biochemistry and Microbiology

We have previously reported that the sodium potassium adenosine triphosphatase (Na/K-ATPase) can effect the amplification of reactive oxygen species. In this study, we examined whether attenuation of oxidant stress by antagonism of Na/K-ATPase oxidant amplification might ameliorate experimental uremic cardiomyopathy induced by partial nephrectomy (PNx). PNx induced the development of cardiac morphological and biochemical changes consistent with human uremic cardiomyopathy. Both inhibition of Na/K-ATPase oxidant amplification with pNaKtide and induction of heme oxygenase-1 (HO-1) with cobalt protoporphyrin (CoPP) markedly attenuated the development of phenotypical features of uremic cardiomyopathy. In a reversal study, administration of pNaKtide after the induction of uremic …

Could The Pharmaceutical Industry Benefit From Full-Scale Adoption Of Radio-Frequency Identification (Rfid) Technology With New Regulations?, Alberto Coustasse Drph, Md, Mba, Mph, Craig Kimble Pharmd, Mba, Ms, Bcacp, Robert B. Stanton Mba, Pharmd, Mariah Naylor

Management Faculty Research

Healthcare regulators are directing attention to the pharmaceutical supply chain with the passage of the Drug Quality and Security Act (DQSA) and the Drug Supply Chain Security Act (DSCSA). Adoption of Radio-Frequency Identification (RFID) technology has the ability to improve compliance, reduce costs, and improve safety in the supply chain but its implementation has been limited; primarily because of hardware and tag costs. The purpose of this research study was to analyze the benefits to the pharmaceutical industry and healthcare system of the adoption of RFID technology as a result of newly implemented supply chain regulations. The methodology was a …

Microchips: Technology That Can Change Medical Services, Dale H. Shao, Ralph E. Mckinney, Lawrence P. Shao

Management Information Systems Faculty Research

Healthcare costs have increased greatly over the last few years. The result is a tremendous burden for businesses and private individuals. Experts say there is no end in sight to this increase. This situation has forced the federal government, state governments, and private industry, to investigate methods to slow down and reduce this constant increase in healthcare costs. Microchip technologies have been presented as a means to ensure better patient care while a/so reducing costs and errors resulting from the current system of healthcare. This paper presents an overview of microchip technology programs, issues with implementation, and future considerations for …

Primary Retroperitoneal Melanoma Presented In A Rare Extracutaneous Site For Malignant Melanoma, Mohamed Alsharedi, Nadim Bou Zgheib, Yousef Khelfa, Ali Raufi, Nabiha Elmsherghi, Yehuda Lebowicz

Hematology and Oncology

Malignant melanoma, as the name implies, is a malignant tumor of melanocytes, found in the skin, eyes, meningeal lining and the mucosal epithelium of the aero-digestive and genitourinary tracts. Malignant melanoma is typically skin malignancy, which rarely presents at extracutaneous site. Here we present a rare case of primary retroperitoneal melanoma and review the findings in comparison with other cases described in literature.

Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse

Management Faculty Research

Medicare fraud and abuse costs are estimated at 3%-10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of HEAT …

Substance Use Disorders In Elderly Admissions To An Academic Psychiatric Inpatient Service Over A 10-Year Period, Dennis Dombrowski, Nelly Norrell, Suzanne Holroyd

Psychiatry

Objective: There is a paucity of research on substance use disorders (SUDs) in the elderly psychiatric population. This study examines SUDs in a geriatric psychiatry inpatient service over a 10-year period.

Methods: Data from 1788 elderly psychiatric inpatients from a ten-year period was collected. Variables collected included psychiatric diagnoses, SUD, number of psychiatric admissions, and length of stay. Those with and without a SUD were compared using Chi-Square or Student’s 𝑡-test as appropriate using SPSS.

Results: 11.7% (𝑁 = 210) of patients had a SUD, and the most common substance was alcohol at 73.3% (𝑁 = 154) or 8.6% of …

Protein Carbonylation Of An Amino Acid Residue Of The Na/K‐Atpase Α1 Subunit Determines Na/K‐Atpase Signaling And Sodium Transport In Renal Proximal Tubular Cells, Yanling Yan, Anna P. Shapiro, Brahma R. Mopidevi, Muhammad Chaudhry, Kyle Maxwell, Steven T. Haller, Christopher A. Drummond, David J. Keendey, Jiang Tian, Deepak Malhorta, Zijian Xie, Joseph I. Shapiro Md, Jiang Liu

Biochemistry and Microbiology

Background We have demonstrated that cardiotonic steroids, such as ouabain, signaling through the Na/K‐ATPase, regulate sodium reabsorption in the renal proximal tubule. By direct carbonylation modification of the Pro222 residue in the actuator (A) domain of pig Na/K‐ATPase α1 subunit, reactive oxygen species are required for ouabain‐stimulated Na/K‐ATPase/c‐Src signaling and subsequent regulation of active transepithelial ²²Na⁺ transport. In the present study we sought to determine the functional role of Pro222 carbonylation in Na/K‐ATPase signaling and sodium handling.

Methods and Results Stable pig α1 knockdown LLC‐PK1‐originated PY‐17 cells were rescued by expressing wild‐type rat α1 and rat α1 with …

The Role Of Na/K-Atpase Signaling In Oxidative Stress Related To Obesity And Cardiovascular Disease, Krithika Srikanthan, Joseph I. Shapiro Md, Komal Sodhi

Biochemistry and Microbiology

Na/K-ATPase has been extensively studied for its ion pumping function, but, in the past several decades, has been identified as a scaffolding and signaling protein. Initially it was found that cardiotonic steroids (CTS) mediate signal transduction through the Na/K-ATPase and result in the generation of reactive oxygen species (ROS), which are also capable of initiating the signal cascade. However, in recent years, this Na/K-ATPase/ROS amplification loop has demonstrated significance in oxidative stress related disease states, including obesity, atherosclerosis, heart failure, uremic cardiomyopathy, and hypertension. The discovery of this novel oxidative stress signaling pathway, holds significant therapeutic

A Rare Association Of Giant Cell Arteritis With Recurrent Corneal Ulcer, Sailaja Bondalapati, Kay Khine, Maya Bitar, David Chesnutt, Richard M. Davis

Ophthalmology

We report a rare case of association of temporal arteritis with recurrent central corneal ulcer. A 91-year-old male with a remote history of clinically diagnosed giant cell arteritis (GCA) and penetrating keratoplasty (PK) for corneal edema in 1990’s in the left eye presented with irritation and severe dry eye. He progressively developed central corneal ulcer regardless of treatment with aggressive lubrication and patching. The clinical course, blood tests and temporal artery biopsy results yielded the diagnosis of recurrent GCA. The clinical course improved after starting oral steroids. The case report illustrates the importance of ruling out GCA in patients with …

Thrombotic Thrombocytopenic Purpura Induced By Acute Pancreatitis, Socrates G. Roedan Md, Nihar Shah Md, Robert Spira Md

Gastroenterology

Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder characterized by clotting in small blood vessels of the body (microthrombi), resulting in a low platelet count. The disease consists of the pentad of microangiopathic hemolytic anemia, thrombocytopenic purpura, neurologic abnormalities, fever and renal disease. Many symptoms could develop with acute pancreatitis but being able to differentiate when it is associated with any hematological conditions such as TTP is crucial to initiate a proper medical treatment. We present a rare case of a thirty-eight years old African American female, who presented to the Emergency department with an abdominal pain associated with …

Spatiotemporal Gait Pattern In Children With And Without Down Syndrome While Walking From Level Surface To Stairs, Huaqing Liang, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Children with Down syndrome (DS) display a delayed motor development, and show clumsy and less coordinated gait pattern. Compared to typically developing children (TD), children with DS walk with a notably slower speed, a shorter stride length, a limited range of motion in ankle joint with increased plantar flexion, and reduced dorsal flexion throughout the gait cycle. When negotiating an obstacle, children with DS show shorter stride length and greater step length variability, and stop in front of the obstacle before stepping over it.

Effect Of Whole Body Vibration On Center Of Mass Movement In Children And Young Adults, Huaqing Liang, Jianhua Wu

Physical Therapy Faculty Research

Whole body vibration (WBV) has acute effects on postural control strategy. The degree of impact depends on the amplitude, frequency, and duration of WBV, and the difficult level of balance task as well as the reliability of sensory information to the individual [1, 2, 3]. Healthy young adults can return to the baseline level of postural sway for a simple balance task within 20 minutes after repeated exposure to WBV [4]. Little is known about the acute and residual effects of WBV on the center-of-mass (COM) movement after a single bout of WBV. This study aimed to understand the COM …

Assessment Of Texan Pharmacists' Attitudes, Behaviors, And Preferences Related To Continuing Pharmacy Education, Fadi M. Alkhateeb, Omar F. Attarabeen, Alameddine Sarah

Pharmacy Practice & Administration

Background: Whether the available Continuing Education (CE) programs meet pharmacists’ continuously increasing needs and preferences is open to question.

Objectives: to investigate pharmacists’ perceptions and attitudes concerning available CE programs, evaluate the pharmacists’ choices with regard to selecting among different CE programs, and investigate the factors that are associated with preference to utilize online CE programs.

Method: A 17-question survey was developed and mailed to a random sample of 600 Texan pharmacists. In addition to collecting basic demographic information, the survey investigated pharmacists’ choices with regard to delivery and content of CE programs, motivations to participation in CE programs, and …

Systemic Air Embolism Associated With Pleural Pigtail Chest Tube Insertion, Emad Alkhankan, Ahmad R. Nusair, Rida S. Mazagri, Mohammed Al-Ourani

Internal Medicine

Pleural pigtail catheter placement is associated with many complications including pneumothorax, hemorrhage, and chest pain. Air embolism is a known but rare complication of pleural pigtail catheter insertion and has a high risk of occurrence with positive pressure ventilation. In this case report, we present a 50-year-old male with bilateral pneumonia who developed a pneumothorax while on mechanical ventilation with continuous positive airway pressure mode .During the placement of the pleural pigtail catheter to correct the pneumothorax, the patient developed a sudden left sided body weakness and became unresponsive. An air embolism was identified in the right main cerebral artery, …

The Future Is In The Numbers: The Power Of Predictive Analysis In The Biomedical Educational Environment, Charles A. Gullo Phd

Biochemistry and Microbiology

Biomedical programs have a potential treasure trove of data they can mine to assist admissions committees in identification of students who are likely to do well and help educational committees in the identification of students who are likely to do poorly on standardized national exams and who may need remediation. In this article, we provide a step-by-step approach that schools can utilize to generate data that are useful when predicting the future performance of current students in any given program. We discuss the use of linear regression analysis as the means of generating that data and highlight some of the …

Carbonylation Modification Regulates Na/K-At Pasesignaling And Salt Sensitivity: A Review And A Hypothesis, Preeya Shah Phd, Rebecca Martin, Yanling Yan, Joseph I. Shapiro Md, Jiang Liu

Biochemistry and Microbiology

Na/K-ATPase signaling has been implicated in different physiological and pathophysiological conditions. Accumulating evidence indicates that oxidative stress not only regulates the Na/K-ATPase enzymatic activity, but also regulates its signaling and other functions. While cardiotonic steroids (CTS)-induced increase in reactive oxygen species (ROS) generation is an intermediate step in CTS-mediated Na/K-ATPase signaling, increase in ROS alone also stimulates Na/K-ATPase signaling. Based on literature and our observations, we hypothesize that ROS have biphasic effects on Na/K-ATPase signaling, transcellular sodium transport, and urinary sodium excretion. Oxidative modulation, in particular site specific carbonylation of the Na/K-ATPase α1 subunit, is a critical step in proximal …

Theaflavin-3, 3'-Digallate Induces Apoptosis And G2 Cell Cycle Arrest Through The Akt/Mdm2/P53 Pathway In Cisplatin-Resistant Ovarian Cancer A2780/Cp70 Cells, Youying Tu, Eunhye Kim, Ying Gao, Gary O. Rankin, Bo Li, Yi Charlie Chen

Pharmacology, Physiology and Toxicology

Ovarian cancer is the most lethal gynecological cancer among women worldwide. Adverse side effects and acquired resistance to conventional platinum based chemotherapy are major impediments in ovarian cancer treatment, and drive the development of more selective anticancer drugs that target cancer-specific defects. In this study, theaflavin-3, 3'-digallate (TF3), the major theaflavin monomer in black tea, exhibited a potent growth inhibitory effect on the cisplatinresistant ovarian cancer A2780/CP70 cells (IC50, 23.81 μM), and was less cytotoxic to a normal ovarian IOSE‑364 cells (IC50, 59.58 μM) than to the cancer cells. Flow cytometry analysis indicated that TF3 induced preferential apoptosis and G2 …

Changes In The Adult Glun2b Associated Proteome Following Adolescent Intermittent Ethanol Exposure, H. Scott Swartzwelder, Mary-Louise Risher, Kelsey M. Miller, Roger J. Colban, Danner G. Winder, Tiffany A. Wills

Biomedical Sciences

Adolescent alcohol use is the strongest predictor for alcohol use disorders. In rodents, adolescents have distinct responses to acute ethanol, and prolonged alcohol exposure during adolescence can maintain these phenotypes into adulthood. One brain region that is particularly sensitive to the effects of both acute and chronic ethanol exposure is the hippocampus. Adolescent intermittent ethanol exposure (AIE) produces long lasting changes in hippocampal synaptic plasticity and dendritic morphology, as well as in the susceptibility to acute ethanol-induced spatial memory impairment. Given the pattern of changes in hippocampal structure and function, one potential target for these effects is the ethanol sensitive …

Improving Rural Bone Health And Minimizing Fracture Risk In West Virginia: Validation Of The World Health Organization Frax® Assessment Tool As A Phone Survey For Osteoporosis Detection, Franklin D. Shuler Md, Phd, Kelly Scott Md, Mph, Timothy Wilson-Byrne Md, Miranda R. Morgan, Linda Morgan

Orthopaedics

West Virginia ranks second nationally in population ≥ 65 years old placing our state at greater risk for osteoporosis and fracture. The gold standard for detecting osteoporosis is dual X-ray absorptiometry (DXA), yet over half of West Virginia’s counties do not have this machine. Due to access barriers, a validated phone-administered fracture prediction tool would be beneficial for osteoporosis screening. The World Health Organization’s FRAX® fracture prediction tool was administered as a phone survey to 45 patients; these results were compared to DXA bone mineral density determination. Results confirmed that the FRAX® phone survey is as reliable as DXA in …

The Impact Of Alzheimer’S Disease In An Aging Rural Population, Lynne J. Goebel, Vivian M. Minkemeyer, Courtney Wellman

Internal Medicine

West Virginia already has a large elderly population, and it is expected to increase along with the elderly population of the nation as a whole. Since the most important risk factor for Alzheimer’s disease is older age, it is not surprising that the prevalence of Alzheimer’s disease is projected to increase significantly over the next thirty-five years. This paper discusses the prevalence of Alzheimer’s disease in West Virginia, programs available to assist people and caregivers affected by the disease, and the associated economic burden of the disease.

Rural Disparities In Cancer Care: A Review Of Its Implications And Possible Interventions, Raj Singh, Lynne J. Goebel Md

Internal Medicine

Cancer care has greatly improved in the last few decades, as evidenced by a 22% decline in the overall cancer-related death rate in the United States since 1991. However, the question presents itself whether rural residents, for whom the latest advancements are not as accessible, are also realizing these benefits as much as their urban counterparts. The aim of this study is to provide are view of the literature regarding the disparities in cancer care facing rural Appalachia and specifically West Virginia (WV) as well as possible solutions towards bridging this gap. We find that WV has a higher cancer …

Chronic Kidney Disease And Acute Myocardial Infarction: The Story After 1 Year, Paulette S. Wehner, William A. Nitardy

Internal Medicine

When chronic kidney disease (CKD) is part of the clinical history for a patient with acute myocardial infarction, the interventional cardiologist experiences an increased anxiety level. An acute myocardial infarction with renal disease requires more attention to dye load and fluid status, and general opinion exists regarding the negative outcomes of these “sicker” patients.

Mark Navarro and colleagues completed a thorough study from a different angle. We know the interventionalists’ concerns are justified acutely as these CKD patients have a higher level of inpatient complications, but these authors chose to look at the patients 1 year from their event to …

Esophageal Diagnosis Of A Malignant Aspergilloma, Muneer Al Zoby, Nancy Munn,, Yousef Shweihat

Internal Medicine

A 59-year-old male patient developed a new 4 cm × 6 cm cavitary left upper lung lesion over a 2 months period. The patient had a prior history of a surgically resected Stage IA non-small cell lung cancer in the right upper lobe 3 years prior. He was treated for possible infection with radiographic improvement on subsequent imaging. Further imaging after 3 months revealed an oval soft tissue density within the cavity with air crescent sign. Bronchoscopy with transbronchial biopsies showed an acute and chronic granulomatous inflammation. Aspergillus fumigatus was noted on culture and voriconazole was initiated. Subsequent imaging showed …