Digital Commons Network^™

Catheter-Associated Urinary Tract Infections: Patient Characteristics, Treatment, And Clinical Outcomes In One South Texas Acute Care Hospital, Kimberly A. Ambrosini, Jose Campo Maldonado

Research Colloquium

Background: Catheter-associated urinary tract infections (CA-UTIs) account for 40 percent of nosocomial infections worldwide. Their elimination is at the forefront of quality improvement in one South Texas acute care hospital.

Methods: Over a period of 6 months, five CA-UTIs occurred in one South Texas acute care hospital. These cases were identified via regular surveillance by Infection Prevention staff and the Laboratory Department of the hospital. This research reviews patient age, sex, length of stay, bacteria contracted, appropriate antibiotic use, patient characteristics, and overall outcomes.

Results: Between the months of July and December 2021, 5 CAUTIs were contracted. Patients ranged in …

A Simple Case Of Viral Myopericarditis Or A Complication Of Monoclonal Antibody Infusion?, Jose A. Rivera, Michael Menowsky

Research Colloquium

Background: Myocarditis has been a rare, but well-documented side effect of the mRNA-based vaccines against SARS-CoV-2 as well as a complication of viral infections including SARS-CoV-2. However, myopericarditis as a complication of monoclonal antibody infusion or as complication of allergic reaction to antibody infusions might be and underreported.

Case presentation: In this case, we report a 30-year-old man with a previous diagnosis of COVID infection 1 week prior to presentation, unvaccinated for SARS-CoV-2 who was referred from a monoclonal infusion center where he received casirivimab and imdevimab and 15 minutes after infusion began to complain of chills, chest pain, shortness …

Covid-19 As A Second Hit For Anti-Phospholipid Syndrome, Himabindu Kolli, Pooja Maknoor, Celin Rajan, Nevin Varghese

Research Colloquium

Background: Anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by venous and arterial thrombosis, usually in setting of underlying autoimmune disorders. Here, we present a case of anti-phospholipid syndrome post covid infection.

Case Presentation: 41-year-old lady presented to the ER with complaints of left sided facial droop for 3-day duration. On further evaluation, she was found to have subacute ischemic stroke and was managed with anticoagulation and supportive treatment. Past medical history is significant for a recent diagnosis of Covid infection and for subsequent development of lower extremity deep vein thrombosis (DVT). She was started on anticoagulation with rivaroxaban for …

Autoimmune Encephalitis Of Unknown Etiology, Elizabeth Cook, Giselle Ricoy

Research Colloquium

Encephalitis is the inflammation of the brain which can come about through various etiologies. Autoimmune encephalitis is a rare form that is most common among women and children. The clinical presentation can vary between patients with a constellation of symptoms including deficits in memory, cognition, seizures, abnormal movement, psychosis, and coma. Because of the variation in clinical presentation and the lack of specificity in imaging and laboratory findings, diagnosis and intervention are often delayed for months to years. These delays in diagnosis can have long term ramifications on patients especially pediatric patients whose neural pathways are still developing. In pediatric …

Effect Of Room Size, Shape, Ac Placement, And Air Leakage On Indoor Airborne Viral Transmission, K. Choudhary, K. A. Krishnaprasad, ‪Nadim Zgheib, M. Y. Ha, S. Balachandar

Mechanical Engineering Faculty Publications

Highlights

• Statistical overloading is used to obtain spatio-temporal pathogen concentration.

• Symmetrically placed AC limits pathogen propagation over long distances.

• Well-mixed model captures room-averaged concentration for any shape and AC location.

• The pathogens level of mixing is reduced when AC is symmetrically positioned.

• Air leakage has insignificant impact on indoor pathogen distribution.

Abstract

We conducted Euler–Lagrange Reynolds-Averaged Navier–Stokes simulations with statistical overloading to investigate the effect of room shape, air-condition (AC) location, and the presence of an open window on indoor airborne viral transmission, particularly as it relates to the spatio-temporal distribution of viral-laden droplet nuclei. Two room geometries were …

A Review On Antibacterial Activity Of Nanoparticles, Badr-Edine Sadoq, Mohammed Reda Britel, Adel Bouajaj, Ramzi Maâlej, Ahmed Touhami, Marwa Abid, Hanen Douiri, Fakhita Touhami, Amal Maurady

Physics & Astronomy Faculty Publications

The increasing resistance of bacteria to antibiotic agents is a main global public health problem. The use of nanoparticles is one of the promising ways to overcome microbial resistance to antimicrobial agents. Metal nanoparticles are increasingly used to target bacterial strains. Advances in nanotechnology, in particular the ability to synthesize nanoparticles of specific size and shape, are likely to lead to the development of new antibacterial agents. The antibacterial activities of nanoparticles are largely influenced by their sizes and large surface area/mass ratio. The antibacterial mechanisms of nanoparticles are poorly understood, but the currently accepted mechanisms include oxidative stress induction, …

Telemedicine Critical Care-Mediated Mortality Reductions In Lower-Performing Patient Diagnosis Groups: A Prospective, Before And After Study, Walter A. Boyle, Christopher M. Palmer, Lisa Konzen, Bradley A. Fritz, Jason White, Michelle Simkins, Brian Dieffenderfer, Ayesha Iqbal, Jill Bertrand, Igor Zwir

School of Medicine Publications

OBJECTIVES:

Studies evaluating telemedicine critical care (TCC) have shown mixed results. We prospectively evaluated the impact of TCC implementation on risk-adjusted mortality among patients stratified by pre-TCC performance.

DESIGN:

Prospective, observational, before and after study.

SETTING:

Three adult ICUs at an academic medical center.

PATIENTS:

A total of 2,429 patients in the pre-TCC (January to June 2016) and 12,479 patients in the post-TCC (January 2017 to June 2019) periods.

INTERVENTIONS:

TCC implementation which included an acuity-driven workflow targeting an identified “lower-performing” patient group, defined by ICU admission in an Acute Physiology and Chronic Health Evaluation diagnoses category with a pre-TCC …

Pediatric Covid-19 Encephalitis, Nelson D. Gonzalez, Dustin Paul, Ana Almeda, Samuel Serna, Linette Linsangan

Research Symposium

Background: Neurologic complications of COVID-19 in the pediatric population have been reported in a limited number of reports. There have been reports of COVID-19-associated encephalitis in pediatric cases along with neuroimaging findings revealing involvement of some parts of the nervous system. We present the first case of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - associated encephalitis targeting the parietal lobes.

Case: A 14-year-old morbidly obese Hispanic male with no past medical history presented to the hospital for new onset seizures. Family reported exposure to his COVID-19 positive mother, a one-week history of fever, and a three-month history of …

Multiple Rsv Strains Infecting Hep-2 And A549 Cells Reveal Cell Line-Dependent Differences In Resistance To Rsv Infection, Anubama Rajan, Felipe-Andres Piedra, Letisha Aideyan, Trevor Mcbride, Matthew Robertson, Hannah L. Johnson, Gina Marie Aloisio, David Henke, Cristian Coarfa, Fabio Stossi, Vipin Kumar Menon, Harshavardhan Doddapaneni, Donna Marie Muzny, Sara Joan Javornik Cregeen, Kristi Louise Hoffman, Joseph Petrosino, Richard A. Gibbs, Vasanthi Avadhanula, Pedro A. Piedra

Research Symposium

Background: Respiratory syncytial virus (RSV) is the major viral driver of a global pediatric respiratory disease burden disproportionately borne by the poor¹. Thus, RSV, like SARS-CoV-2, combines with congenital and environmental and host-history-dependent factors to create a spectrum of disease with greatest severity most frequently occurring in those least able to procure treatment.

Methods: Here we apply whole genome sequencing and a suite of other molecular biological techniques to survey host-virus dynamics in infections of two distinct cell lines (HEp2 and A549) with four strains representative of known RSV genetic diversity.

Results: We observed non-gradient patterns of RSV …

Immunepotent Crp Enhances Cyclophosphamide-Induced Cytotoxicity Through A Caspase Independent But Ros Dependent Mechanism In Triple Negative-Breast Cancer Cells, Ana L. Rivera, A. C. Martínez-Torres, C. Rodríguez-Padilla

Research Symposium

Background: Breast cancer (BC) is one of the leading causes of cancer death worldwide. Cyclophosphamide (CYP) remains a mainstay in cancer therapy mainly in the triple negative breast cancer subtype (TNBC) in spite of harmful adverse effects and cell death-resistances. To face this, combination of chemotherapies and immunotherapies has been proposed. IMMUNEPOTENT CRP (ICRP) is an immunotherapy that has cytotoxic effects in several cancer cells without affecting peripheral blood mononuclear cells (PBMC) and CD3+ cells, beside improving clinical parameters of chemotherapy-treated patients. The aim of this study was to evaluate the mechanism of cytotoxicity induced by ICRP in combination with …

Expanding Health Professional Education In The Rio Grande Valley During The Covid-19 Pandemic, Sabrina R. Orta, Samantha G. Alvarado, Shuchita Jhaveri

Research Symposium

Purpose: The COVID-19 Pandemic has prompted innovation in health professional education, such that learners are able to recognize and mitigate healthcare disparities in the outcomes of vulnerable populations. The objective of our project was to increase education on preventing, preparing for, and responding to COVID-19 and other locally prevalent infectious diseases that disproportionately affect RGV communities.

Description: This project had 3 goals: (1) provide learners with virtual patient-interaction simulations (2) provide interactive training modules on the identification, prevention, and treatment of infectious diseases affecting South TX and strategies to increase child vaccinations, and (3) provide learners an opportunity to coordinate …

Antibody Mediated Targeted Drug Delivery System To Improve Immunotherapy In Pancreatic Cancer, Poornima Devi Shaji, Meena Jaggi, Murali M. Yallapu, Subhash C. Chauhan, Sheema Khan

Research Symposium

About 95% of tumor arises from epithelial cell lining ducts known to be pancreatic ductal adenocarcinomas, with less than 5-7% survival rate. Unfortunately, little progress has been seen in the outcomes of patients with PDAC as tumor develops high desmoplasia and chemo-resistance to chemotherapeutic drugs, such as gemcitabine (Gem). Immunotherapy has shown promising results in cancers, except pancreatic cancer due to their characteristic fibrotic tumor microenvironment. The therapies are unable to penetrate to the fibrotic tumors leading to insufficient availability of the therapeutic drugs at the tumor site. A recently identified mucin, MUC13 is aberrantly expressed in pancreatic tumors but …

Clinical And Social Profile Of Patients With Pulmonary Tuberculosis In Reynosa, Tamaulipas, Selena Zavala-Pérez, Erika A. Vargas-Orozco, Juan Carlos Hernandez-Martinez, José Francisco Flores-Gómez, Marisol Rosas-Diaz, Esperanza Milagros Garcia-Oropesa

Research Symposium

Background: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It generally causes pulmonary tuberculosis, with symptoms such as fever and expectoration. In 2020, the total number of tuberculosis cases worldwide was about 9.8 million, with a mortality of 1.5 million. In Mexico, pulmonary tuberculosis represents 79% of the total cases of tuberculosis, with an incidence of 24 cases per 100,000 inhabitants. Tamaulipas ranks fifth nationally. This study seeks to determine the frequency in which social and risk factors associated with predisposition to tuberculosis occur in the population of Reynosa, Tamaulipas.

Methods: Through an observational and descriptive study, data were …

Without A Rash! A Diagnostic Dilemma For Vzv Vasculopathy, Paulina Vega Enriquez, Jose E. Campo Maldonado

Research Symposium

Varicella zoster virus vasculopathy is a condition that can classically present with a dermatomal zoster rash followed by a neurological deficit. The possible neurological manifestations and disease range are extensive. Diagnosis becomes more challenging in patients whose presentation does not include a rash, often causing cognitive errors and delay in treatment. We present a case of an 85-year-old patient, who developed stroke-like symptoms, initially with normal MRI, to later progress to multiple evolving enhancing lesions seen in subsequent MRIs. This case also represents the anchoring, that we as physicians can have when a patient with risk factors for stroke or …

Patchy Alopecia In A Young Adult With A Generalized Rash, Oscar Rodrigo Zamudio Herrera, Nevin Varghese

Research Symposium

Background: Syphilis is a sexually transmitted infection that has been increasing in the United States. The prevalence of syphilis rose by 6.8% during 2019-to 2020. Secondary syphilis typically presents with a generalized maculopapular rash on palms and soles, however, can also have subtle dermatological findings such as alopecia. Syphilitic alopecia is an atypical manifestation of secondary syphilis, seen in 2.9 to 7% of the cases.

Case presentation: An 18-year-old Hispanic male presented to the clinic after noticing patchy loss of hair on the scalp for 2 weeks and one week of generalized non pruritic rash. His past medical history was …

Culture-Negative Endocarditis Complicated With Mycotic Aneurysm And Intracranial Bleed - A Case Report, Jose A. Rivera, Daniel Aragon, Michael Menwosky, Juan Padilla

Research Symposium

Background: Blood culture-negative infective endocarditis (IE) requires at least three independent blood samples with negative cultures after seven days of incubation. Ischemic events are the most frequent neurologic complication of IE with intracranial mycotic aneurysms being the consequence of displacement of septic emboli from valvular vegetations. In this case report, we describe a young gentleman who initially presented with neurologic deficit and was later found to have mycotic aneurysms and culture negative infective endocarditis.

Case Presentation: A 34-year-old man with a past medical history of Tourette Syndrome presented to the Emergency department (ED) due to acute change in mental status. …

A Case Report Of A Primary Cerebral Abscess Due To Nocardia Asteroides In An Immunocompetent Patient, Ileana Elita Mendez, Nicole Marie Barreto, Alan Lanurias, Luis Alberto Rosas

Research Symposium

Background: Brain abscesses caused by Nocardia are rarely reported and have high mortality. It usually affects patients who are immunocompromised and initiates as a lung infection that disseminates hematogenously, though it can also affect those immunocompetent. Cerebral nocardiosis imitates brain tumors, which can delay the initiation of the appropriate antibiotic therapy.

Case Description: We present a case of a 64-year-old immunocompetent male with multiple cerebral abscesses who presented with headaches, left-sided weakness, and ataxia. Upon imaging, multiple brain lesions were revealed. The patient underwent craniotomy and drainage of the mass. He was initially empirically treated, though cultures later grew Nocardia …

Cms Sepsis Bundle Compliance Analysis At The Time Of Patient Admission During The Covid-19 Pandemic In A Community Hospital In South Texas, Jose Ramos, Daniel Habenicht, Carlos Ramos

Research Symposium

Background: Sepsis remains an important cause of mortality in hospitals across the globe. The Centers for Medicare and Medicaid Services (CMS) have increased efforts to lower the mortality rate in sepsis patients via the CMS quality measure. The COVID-19 pandemic changed how we conduct healthcare and key elements of sepsis management might have been compromised, affecting the CMS sepsis bundle compliance rate. Our goals were to determine whether compliance rates were affected and to further analyze the mortality rates associated with sepsis management during the COVID-19 pandemic.

Methods: A retrospective chart review was conducted to analyze the adherence to the …

Bitten To The Bone: A Case Of Anxiety-Induced Osteomyelitis, Jose A. Rivera, Daniel Aragon, Daniela Hernandez

Research Symposium

Background: Onychophagia is a habitual nail-biting disorder, usually associated with mental or emotional diseases. It affects 20–30% of the population in all age groups. Human bites have the potential to become serious injuries due to high virulence in the human oral flora and may often require hospital admission, antibiotics and even debridement in the operating room. Thus, repetitive nail biting has the potential to be limb-threatening if not treated early and appropriately.

Case Presentation: Patient is a 49-year-old gentleman with a past medical history of severe refractory anxiety treated with hydroxyzine and scheduled alprazolam, after failing multiple other treatments, …

Self-Organization For Community Resilience In An Invisible Agricultural Community, Anna Erwin, Chelsea A. Silva, Zhao Ma

School of Earth, Environmental, & Marine Sciences Faculty Publications

This study investigates how self-organizing efforts by residents of informal settlements, primarily migrant and informal farmworkers, shape community resilience in Majes, a water-scarce irrigation district in the Atacama Desert of Peru. We collected 45 semi-structured interviews with residents and authorities in Majes and analyzed findings through a framework of self-organizing. Analyses revealed that self-organizing by residents of informal settlements incorporated the three components of White’s theory of Community Agency and Community Resilience, which contends that marginalized communities increase resilience by fostering a commons praxis, practicing a prefigurative politics, and developing opportunities for economic autonomy. We also found …

Stability Analyses On The Effect Of Vaccination And Contact Tracing In Monkeypox Virus Transmission, Solomon Eshun, Richmond Essieku, James Ladzekpo

School of Mathematical & Statistical Sciences Faculty Publications

Monkeypox is a significant health concern due to its potential for morbidity and occasional mortality. Vaccination and effective contact tracing play pivotal roles in controlling infectious diseases, including monkeypox. This study aims to contribute to our understanding of monkeypox dynamics by developing a comprehensive mathematical model that incorporates key factors such as vaccination, quarantining, and contact tracing. Through rigorous sensitivity analysis, we explore the impact of varying vaccination coverage and contact tracing on the disease’s dynamics. In particular, we investigate the dynamics of the disease in relation to variable vaccination coverage and contact tracing. Our findings highlight the critical role …

Sick From Freedom: The Untold Story Of A Smallpox Epidemic Among Formerly Enslaved People, Jim Downs

Rondel V. Davidson Endowed Lecture Series

Emancipated from slavery, former bondspeople entered into an environment in which more soldiers died from disease than from battle. This talk explores the high rate of illness and mortality that devastated formerly enslaved people during the Civil War and Reconstruction. In particular, it provides the first analysis of the smallpox epidemic that began in Washington, DC in 1862 and then spread to the Lower South in 1863 and Mississippi Valley in 1864-65. By 1865, the epidemic plagued the entire South and began to move west and infected Native Americans on reservations. Due to the unexpected and inordinate mortality, the federal …

Vertical Transmission Of Zika Virus In Monodelphis Domestica, Mohini Moulick

Theses and Dissertations

Zika Viral infection in pregnant women may lead to infants born with microcephaly and other neurological complications, making Zika viral research imperative. Prior research demonstrated Monodelphis domestica to be a unique animal model for Zika virus studies, and viral proteins were detected in brain tissue of juveniles after intracerebral inoculation of infants. We wanted to determine if we can detect a viral protein, non-structural protein 1 (NS1), in brain tissue after intraperitoneal inoculation and we found it to be possible through immunohistochemistry (IHC) analysis. We also investigated if inoculated dams (mothers) would give rise to Zika positive pups (natural inoculation), …

Mönckeberg's Medial Calcific Sclerosis Makes Traditional Arterial Doppler's Unreliable In High-Risk Patients With Diabetes, Mehmet A. Suludere, Sahab K. Danesh, Amanda L. Killeen, Peter A. Crisologo, Matthew Malone, Michael C. Siah, Lawrence A. Lavery

School of Podiatric Medicine Publications

Objective

To assess Mönckeberg's medial calcific sclerosis (MMCS) severity in patients with a diabetic foot infection.

Methods

This was an analysis of 2 randomized clinical trials in which we evaluated the treatment of 233 patients admitted to the hospital for moderate and severe foot infections. Arterial calcification was defined as visible radiopaque arteries on foot and ankle radiographs, recorded as the most distal visible artery involved (toes, metatarsals, and ankle/hindfoot).

Results

Most subjects (57.1%, n = 133) had MMCS, with extension to toes in 79 (59.4%), to metatarsals in 32 (24.1%), and to ankle/hindfoot in 22 patients (16.5%). In 7 …

The Effect Of Third Dose Of Pfizer/Biontech And Moderna Covid-19 Mrna Vaccines On Igg Antibody Titers, Thao A. Khuc, Gregery Pequeno, Monica M. Betancourt-Garcia, Adrienne M. Casciato, Marissa Gomez-Martinez, Carlos D. Arroyo, Bill D. Pope Iii, Shravan Narmala, Sohail Rao

School of Medicine Publications

With the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, the Centers for Disease Control and Prevention (CDC) authorized the third dose of the Pfizer-BioNTech (BNT162b2) vaccine with the rationale for prolonged elevation of anti-SARS-CoV-2 antibody titers and protection against the SARS-CoV-2 virus.

To better understand how administration of the third dose of the Pfizer/BioNTech coronavirus disease 2019 (COVID-19) vaccine affects the incidence and severity of SARS-CoV-2 infections, we administered the third dose of the Pfizer-BioNTech (BNT162b2) to 189 participants. Blood samples were collected from participants during each of their scheduled visits (baseline, week two, week 12, and …

Ticks And Tick-Borne Pathogens From Wild Pigs In Northern And Central Florida, Sarah E. Mays Maestas, Lindsay P. Campbell, Michael P. Milleson, Lawrence E. Reeves, Phillip E. Kaufman, Samantha M. Wisely

School of Integrative Biological & Chemical Sciences Faculty Publications

Simple Summary

Ticks are vectors of several agents of human disease, and improvements to traditional surveillance methods are needed to aid in tick-borne disease monitoring and prevention. Invasive wild pigs are broadly distributed in the southern U.S., and removal efforts are often undertaken by local, state, and federal entities. Wild pigs are hosts to several human-biting tick species associated with agents of human disease. This research examines the use of tick collection from wild pigs in the state of Florida as a method of surveillance for ticks and tick-borne pathogens of human concern. Four species of human-biting ticks were collected …

Crotalus Scutulatus Scutulatus Crude Venom And Its Purified Cysteine-Rich Secretory Protein (Css-Crisp), Armando Reyes, Joseph D. Hatcher, Emelyn Salazar, Jacob Galan, Anton Iliuk, Elda E. Sanchez, Montamas Suntravat

School of Medicine Publications

Increased vascular permeability is a frequent outcome of viperid snakebite envenomation, leading to local and systemic complications. We reported that snake venom cysteine-rich secretory proteins (svCRiSPs) from North American pit vipers increase vascular permeability both in vitro and in vivo. They also induce acute activation of several adhesion and signaling molecules that may play a critical role in the pathophysiology of snakebites. Extracellular vesicles (EVs) have gained interest for their diverse functions in intercellular communication, regulating cellular processes, blood-endothelium interactions, vascular permeability, and immune modulation. They also hold potential as valuable biomarkers for diagnosing, predicting, and monitoring therapeutic responses in …

Proteomic Profiling Of Extracellular Vesicles Isolated From Plasma And Peritoneal Exudate In Mice Induced By Crotalus Scutulatus Scutulatus Crude Venom And Its Purified Cysteine-Rich Secretory Protein (Css-Crisp), Armando Reyes, Joseph D. Hatcher, Emelyn Salazar, Jacob Galan, Anton Iliuk, Elda E. Sanchez, Montamas Suntravat

School of Medicine Publications

Increased vascular permeability is a frequent outcome of viperid snakebite envenomation, leading to local and systemic complications. We reported that snake venom cysteine-rich secretory proteins (svCRiSPs) from North American pit vipers increase vascular permeability both in vitro and in vivo. They also induce acute activation of several adhesion and signaling molecules that may play a critical role in the pathophysiology of snakebites. Extracellular vesicles (EVs) have gained interest for their diverse functions in intercellular communication, regulating cellular processes, blood-endothelium interactions, vascular permeability, and immune modulation. They also hold potential as valuable biomarkers for diagnosing, predicting, and monitoring therapeutic responses in …

Red Breast Syndrome And Acellular Dermal Matrix, Allison Podsednik Gardner, Aidee Nunez, Mauricio De La Garza

School of Medicine Publications

Increasingly popular for use in breast reconstruction, acellular dermal matrix (ADM) can provide support and protection to implants. However, use of ADM may be associated with infection and complications, including red breast syndrome (RBS). RBS is an inflammatory event that typically presents with cutaneous erythema over the domain where the ADM is surgically implanted. As ADM use increases, presumably, more cases of RBS will occur. Thus, techniques and tools to mitigate or manage RBS are needed to improve patient outcomes. Here, we describe a case where RBS was diagnosed and interestingly resolved after exchange for a different brand of dermal …

Deeper Seated Than Skin Deep: Report Of A Rare Case Of Follicular Occlusion Tetrad And A Literature Review, Yilen K. Ng-Wong, Blesset Alexander, Mery Bartl, Christine E. Loftis, Dina Hammad, Emilia C. Dulgheru, Mauricio De La Garza, Aidee C. Nunez

School of Medicine Publications

Follicular occlusion tetrad (FOT) is a clinical syndrome consisting of hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal cyst (PC). These entities typically occur independently, but occasionally present simultaneously comprising FOT. The four components share similar pathophysiology affecting the apocrine glands, follicular hyperkeratinization being the hallmark of each entity.Understanding shared similarities of each disease is paramount for the treatment approach as the relapsing and chronic nature of this syndrome can be burdening to patients. We present the case of a 22- year-old obese Hispanic man with a history of tobacco use who presented with …