Medicine and Health Sciences Commons^™

Simultaneous Brachial Artery Injury And Ulnar Nerve Palsy: A Case Study Of An Atv Accident Survivor, Ryan Bialaszewski, Sidney Selva, Shuaibahmed M. Arab, Pamela Campos, Elizabeth Althaus, Chelsea Chang

Research Symposium

Background: All-terrain vehicle (ATV) accidents are a common cause of traumatic elbow injuries due to outstretched arms accepting contact at greater forces. However, their complexity and clinical significance often go unrecognized upon initial evaluation, especially in patients without acute fractures. Sequelae of such injuries can include neurovascular deficits, leading to chronic pain, limb ischemia, and paresthesias. This article aims to present a case study detailing a post-traumatic elbow injury with chronic neurovascular deficits following an ATV accident. Additionally, we address common clinical findings in post-traumatic concomitant brachial artery and ulnar nerve injuries, their evaluation, and respective management plans.

Case Presentation: …

Mycotic Aneurysms In Fungal Meningitis: The Management In A Case Of Fusarium Solani Meningitis, Ruayda Bouls, Duc Khiem Ngo, Jose E. Campo Maldonado

Research Symposium

Introduction:

We present a 31 y.o previously healthy woman who developed Fusarium solani fungal meningitis after undergoing cosmetic surgeries in Mexico. Fungal meningitis and particularly F. solani meningitis is very rare, and little is known about the extent and frequency of neurovascular complications in patients with this condition. To our knowledge, previous reports of fungal meningitis don’t recognize or emphasize enough the importance and extension of neurovascular complications noticed in our patient.

Case Presentation: A 31-year-old female presented with severe headaches and intermittent fever, two weeks after receiving epidural anesthesia during cosmetic surgery near the Texas-Mexico border. Lab results showed …

Avoiding A Perfect Storm: Delving Into The Consequences Of A Complex Case Of Superimposed Cellulitis After A Herpes Zoster Infection, Ruayda Bouls, Ed Wong Alvarado, Daniel Ibarias Paz, Yuri Cuellar De La Cruz

Research Symposium

Introduction: Cellulitis is an acute bacterial infection causing inflammation affecting the deep dermis layer as well as the surrounding subcutaneous tissue that does not contain an abscess. In this case study we aim to describe the clinical presentation of a middle aged Hispanic woman who developed a superimposed cellulitis infection following a flare-up of a zoster infection. Herpes Zoster is typically considered a typically benign infection but in immunocompromised individuals severe complications of the infection include bacterial superinfections, coagulopathies including disseminated intravascular coagulation, and central nervous system manifestations including encephalopathy with long term detrimental outcomes [1]. Management of Herpes Zoster …

Comatose Deception, Benzodiazepine Masquerade Of Myxedema Coma, Roy Subash Kondapavuluru, Sabhi Gull, Hemaswini Kakarla, Reshmanth Prathipati, Andres Suarez Parraga

Research Symposium

Introduction: Myxedema coma is a life:-threatening condition due to severe hypothyroidism or long-standing untreated hypothyroidism. This condition can be triggered by factors such as infection, exposure to certain medications, or other stressors on the body. Symptoms of myxedema coma include hypothermia, altered mental status, and fluid accumulation. This condition can be life threatening and requires immediate medical attention.

Benzodiazepines are often prescribed to address various conditions such as anxiety, sedation, and seizures. However, they have significant side effects including drowsiness, sedation, low blood pressure, and slow heart rate. These side effects can mimic symptoms of other conditions such as myxedema …

When Medications Collide: Demystifying Drug-Induced Hyponatremia In A Complex Medical Case, Roy Kondapavuluru, Jian Garcia Cruz, Manaswini Kakarla, Ram Maganti, Akshay Pingilati, Andres Suarez Parraga

Research Symposium

Introduction: Hyponatremia, defined as serum sodium below 135mEq/L( normal range:136-145mEq/l), is a medical emergency associated with various complications. Sodium is an important electrolyte that helps regulate fluid balance and nerve/muscle function. Severe hyponatremia may not show obvious symptoms initially but can eventually manifest as nausea, vomiting, fatigue, impaired movement, and in extreme cases, seizures, coma, respiratory failure, or even death.

Thiazide diuretics have been associated with hyponatremia with a sodium level as low as 99mEq/L. In our case, the patient was on bumetanide, a loop diuretic and she developed hyponatremia which worsened with additional metolazone treatment to a sodium level …

“Blood, Blood Everywhere”: A Case Of Buried Bumper Syndrome Presenting As Melena And Hematochezia, Roy Subash Kondapavuluru, Baron S. Ekeledo, Jian Garcia Cruz, Eunbee Cho, Balakrishna Ravella, Sudheer K. Kanumari

Research Symposium

Gastrostomy tubes are frequently placed for a variety of conditions that cause interference with oral intake or gastric decompression and are used for enteral feeding, hydration, and medication administration in patients who are likely to have prolonged inadequate oral intake. Buried bumper syndrome is an extremely rare, but major complication of gastrostomy tubes which results due to tight apposition of the external bumper against the abdominal wall and erosion of the internal bumper of the gastrostomy tube against the gastric wall. The overall incidence has been reported to be 0.3 to 2.6 % of all patients with gastrostomy tubes. We …

Tick-Borne Illness In A Guatemalan Migrant, Radhika Mehta, Bareera Akhtar

Research Symposium

Abstract: Migration is a complex phenomenon that involves numerous physical and psychological challenges, particularly for individuals undertaking long and arduous journeys. In the case of this 39 year old Guatemalan man, his perilous 25-day journey crossing forests to reach the United States resulted in severe health consequences, including dehydration, acute kidney injury and a possible tick-borne illness. This case report aims to shed light on the healthcare needs of migrants and emphasizing the importance of providing comprehensive care.

A 39 year old male from Guatemala presented to the emergency department with diffuse abdominal pain associated with nausea, vomiting and a …

Clinical Management Of Larsen Syndrome In Inpatient Rehabilitation: A Case Report, Philippe J. Dentino

Research Symposium

Background: Larsen Syndrome is a rare osteochondrodysplasic disorder associated with Filamin 1 (FLN) gene mutations and clinically presents with frequent large joint dislocations, osseous disturbances, and craniofacial abnormalities. To date, no studies have assessed the medical and rehabilitative management of an individual living with Larsen Syndrome in an inpatient rehabilitation care setting.

Case Presentation: A 30 year-old biological female presented to the emergency department after developing worsening right-sided low back pain while bending forward. The patient’s past medical and surgical history was significant for Larsen Syndrome complicated by chronic hip, knee, and back pain, Celiac disease, major depressive disorder, post-traumatic …

Mystery Case: An Effort To Diagnose A Patient With A Decade Of Relapsing And Remitting Neurologic Symptoms With A Comprehensive Medical Approach, Pamela Campos, Sidney Selva, Ryan Bialaszewski, Elizabeth Althaus, Shuaibahmed M. Arab, Chelsea Chang

Research Symposium

Background: Muscle weakness and numbness are prevalent complaints amongst patients and can have a varying range of diagnoses from benign inconsequential to life-threatening causes. The pattern and intensity of weakness, accompanying symptoms, medication use, and family history assist the physician in determining if a patient's presentation is caused by infectious, neurologic, metabolic, inflammatory, psychiatric, or drug-induced condition.

Case Presentation: Our patient is a 37-year-old female who presents to the clinic for a follow-up. The patient has a past medical history of Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and an undiagnosed neuromuscular weakness for approximately 10 years. The weakness …

New Onset Bilateral Pleural Effusion: An Uncommon Presentation Of Subclinical Hypothyroidism Or A Premature Closure Diagnosis Error?, Molly Chapman, Andrea Soto Abarca, Duc Khiem Ngo, Carlos T. Ramos

Research Symposium

Background: Subclinical hypothyroidism is biochemically defined with normal serum-free T4 in the presence of an elevated serum TSH. Common symptoms of an underactive thyroid can include fatigue, weakness, cold intolerance, weight gain despite poor appetite, hair loss, constipation, and depression. Pleural effusions have also been recognized as a clinical sequelae in the literature, where up to 25% of patients can develop a pleural fluid collection in the setting of hypothyroidism. Although not well understood, a mechanism includes an increased capillary permeability that leads to the retention of fluid in pleural cavities and other tissues.

Case presenting: A 66-year-old woman …

A Rare Case Of Acute Pancreatitis Associated With Cannabinoids Consumption, Mays Abdulazeez, Michael Perez, Alejandro Hidalgo Parada, Rani Rabah, Greity Dominguez, Rowel Perez Vargas, Jose Cano, Jesus Garza-Tamez, Sunand Kallumadanda

Research Symposium

Introduction: Acute pancreatitis is an inflammatory condition of the pancreas characterized by abdominal pain and elevated levels of pancreatic enzymes in the blood. Acute pancreatitis is a leading gastrointestinal cause of hospitalization in the United States. Several conditions are associated with acute pancreatitis, of which gallstones and chronic alcohol use disorder account for approximately two-thirds of the cases. Others, including smoking, hypertriglyceridemia, infections, trauma, drugs, malignancy, scorpion stings, hypercalcemia, endoscopic retrograde cholangiopancreatography (ERCP), opioids, angiotensin-converting enzyme (ACE) inhibitors, macrolides, diuretics, statins, and cannabis have also been associated with acute pancreatitis. Cannabis is the most widely used recreational drug worldwide, with …

From Carious To Salivarius: A Case Of Streptococcus Salivarius Infective Endocarditis, Maria E. Torres Perez, Ed Wong Alvarado, Cecilia Salinas Domene, Jennifer Rojas Huen, Sara G. Mojica, C. Garza, Usman Sheriff

Research Symposium

Background: Streptococcus salivarius forms part of the Viridans family which accounts for almost 40% of all endocarditis cases. However, S.salivarius is only attributed to 2% of those cases. In the most common setting, S.salivarius is a commensal bacterium of both the oral mucosa and the gut, but it has proven to have infective potential. S.salivarius accounts as an easily missed and commonly misdiagnosed Viridians strep species, but has been implicated as a rare cause of infective endocarditis.

Case presentation: We present the case of a 43-year-old male who presented with worsening fatigue, chest pain, shortness of breath, and subjective fever. …

Sudden Cardiac Death Due To Pharmacological Cardioversion Of Atrial Fibrillation, Manlio F. Lara Duck, Juan Rosales-Martínez, Netzahualcoyotl Mayek Pérez

Research Symposium

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia. The global prevalence of AF is 0.51% of the world population (37.5 million people) and has increased 33% in the last 20 years. AF may be associated with increased risk of sudden cardiac death (SCD); as well as ischemic stroke or coagulopathies. Coronary heart disease and heart failure are the two most common substrates of SCD. Therefore, the relationship between AF and SCD is particularly difficult to address. AF may have a shared molecular basis with ventricular fibrillation (VF; the most common arrhythmia underlying SCD), as both involve cellular …

Use Of Translational Science, Continuous Glucose Monitoring In The Primary Care Setting For Management Of Nesidioblastosis. A Case Report, Karuna Manandhar, Othman Farahneh, Gerardo Munoz-Monaco

Research Symposium

Background: Nesidioblastosis is a term used to describe histologic changes in the pancreatic cell defined by beta cell hypertrophy and formation of ductoinsular complexes. It is a disease previously most extensively identified in neonates and is a rare cause of endogenous hypoglycemia in the adult population. However, with increasing numbers of gastric bypass surgeries for management of obesity in recent years, there has been a growing number of populations with post gastric bypass surgery related nesidioblastosis.

Case Description: Our case report follows a 60-year-old female with previous history of Roux-en-Y gastric bypass surgery who initially presented to an acute-care hospital …

Asymptomatic Spontaneous Pneumopericardium In A Young Post-Covid-19 Patient: A Case Report, Jose Gomez Casanovas, Andreina Baird Borja, Eric Sanchez, Alcibiades Fleires, Daniela Hernandez

Research Symposium

Background: Pneumopericardium is a rare clinical condition which is defined as the presence of air or gas in the pericardial cavity. Although uncommon to see, it can present after chest trauma, barotrauma, fistula between the pericardium and surrounding structures, gas producing microorganisms and iatrogenic causes. But spontaneous presentations are even more uncommon. Coronavirus Disease 2019 (COVID 19) infection became a large global epidemic and in addition to respiratory symptoms, involvement of other organs such as pericardium was also reported. We here present a young patient post COVID 19 infection with isolated spontaneous pneumopericardium.

Case Presentation: A 19 year old patient …

A Case Of Recently Diagnosed Uncontrolled Hyperthyroidism Associated With Bilateral Pulmonary Embolism, Jose Gomez Casanovas, Mery Bartl, Lina Pedraza Sanchez, Alcibiades Fleires, Andres Suarez Parraga

Research Symposium

Background: Pulmonary embolism (PE) is a relatively common acute cardiovascular disorder with considerable mortality, despite advances in diagnosis and treatment. In 25 to 50% of first-time cases, no readily identifiable risk factor can be found. Several studies have suggested hyperthyroidism to be a potential hypercoagulable and hypofibrinolytic state. In this case, we present a patient with uncontrolled hyperthyroidism with incidental bilateral PE.

Case Presentation: A 47-year-old Hispanic lady with past medical history of recently diagnosed hyperthyroidism who was not compliant with medical therapy, presented to the emergency department with 4-hour history of chest pain. She described it as sudden onset, …

Transient Sinus Node Dysfunction In A Postpartum Female With Sinus Bradycardia: A Case Report, Jose Gomez Casanovas, Andreina Baird Borja, Laura Rincon-Rueda, Mery Bartl, Daniela Hernandez

Research Symposium

Background: Conduction disorders are common cardiac complications during pregnancy in women with and without structural heart disease. Sinus bradycardia has been described in few case reports secondary to increased vagal tone. Prevalence of newly acquired sinus node dysfunction without structural heart disease is unknown. In this case, we present a post-partum female with symptomatic acquired sinus node dysfunction who presented with severe sinus bradycardia.

Case Presentation: A 32-year-old Hispanic lady with a past medical history of obesity and obstetric formula of G4P4, who recently delivered her 4th child via C-section 4 weeks prior, presented to the Women´s Hospital as a …

Enterococcus Avium Peritonitis, Jian Garcia Cruz, Johanne Chaglasian, Oliverio Abarca Guzman

Research Symposium

Introduction: Enterococcus spp. are part of normal human GI tract flora which has been known to cause community acquired UTI, bacteremia, and nosocomial infections. Enterococcus faecalis and faecium are the most commonly isolated pathogens within enterococcus family although there have been few to no cases reported of peritonitis secondary to enterococcus avium in the setting of recent paracentesis and end-stage-liver disease. The incidence of peritonitis from rare organisms is increasing because of improved microbiological identification techniques. This case is relevant because it shows us that enterococcus avium even if it is not common show be considered when choosing antibiotics coverage …

Spontaneous Iliopsoas Hematoma Secondary To Warfarin Toxicity, Jian Garcia Cruz, Julio Perez Rodriguez, Roy Subash Kondapavuluru, Oliverio Abarca Guzman, Johanne Chaglasian, Jonathan Yaw Gyebi-Agyepong

Research Symposium

Abstract: Warfarin is a commonly prescribed anticoagulant with a narrow therapeutic window. The prevalence of retroperitoneal hematoma in the general population is not well documented, but it is estimated to be less than 1%. However, the incidence is higher in patients taking anticoagulants such as warfarin, with some studies reporting an incidence as high as 3-6%. Iliopsoas hematoma is reported in literature with frequent non-specific symptoms ranging from abdominal, leg and thigh pain. It is important to recognize them due to the high mortality. This paper aims to demonstrate that patients on warfarin with low hemoglobin and purplish bruises of …

Syncope As A Presentation Of Waldenstrom Macroglobulinemia, Jian Garcia Cruz, Julio Perez Rodriguez, Roy Subash Kondapavuluru, Eunbee Cho

Research Symposium

Abstract: Syncope as defined by ACC/AHA is defined as a symptom that presents with an abrupt, transient, complete loss of consciousness, associated with inability to maintain postural tone, with rapid and spontaneous recovery without clinical features of other non-syncope causes of loss of consciousness, such as seizure, antecedent head trauma, or apparent loss of consciousness. Syncope is a common complaint treated in the emergency department and a major reason for hospital admissions. Identification of the etiology of syncope is important for diagnostic and therapeutic purposes. Syncope is a symptom as a presentation with multiple differential diagnosis listed and clearly explained …

Grey Turner's Sign Unveiling A Rare Case Of Neuroendocrine Tumor In The Tail Of The Pancreas: A Reminder To Expand The Differential In Young Patients With Chronic Back Pain, Jennifer Rojas Huen, Gilbert Flores Jr., Ismael Pavel Polo Pérez, Nabeel Sarhill

Research Symposium

Background: Pancreatic cancer is often difficult to diagnose due to its asymptomatic nature, silent progression or symptoms overlapping with more common benign conditions. We present a case of a 30-year-old male with chronic worsening back pain, weight loss, and Grey Turner's sign, ultimately leading to the diagnosis of a neuroendocrine tumor in the tail of the pancreas. The rarity of this diagnosis in a young patient with atypical symptoms emphasizes the importance of considering uncommon diagnoses and expanding differentials, even when presented with seemingly typical symptoms, to enable early detection and intervention.

Case Presentation: 30-year-old male past medical history of …

Submental Intubation In Oral Maxillofacial Surgery: A Case Report And Review Of Indications And Complications, Jennifer Inofomoh, Mark Lavering, Ed Wong Alvarado, Diego Aleman

Research Symposium

Introduction/Background: Submental intubation is a valuable alternative airway management technique employed in oral maxillofacial surgery when intraoral or nasal intubation is contraindicated or poses a potential risk (Schütz, 2008). This case report presents a clinical scenario in which a patient underwent oral maxillofacial surgery necessitating submental intubation. Additionally, we review the indications, technique, and potential complications associated with this specialized intubation approach.

Oral maxillofacial surgeries frequently involve complex fractures, extensive soft tissue injuries, or anatomical variations that preclude traditional intraoral or nasal intubation. Submental intubation provides a safe and effective option in such cases, avoiding the need for tracheostomy or …

Wait, Wait, Could It Be Autoimmune Pancreatitis? A Case Of Localized Autoimmune Pancreatitis Mimicking Pancreatic Cancer, Grecia Dominguez Rivera, Hari Movva, Heriberto Cantu, Nabeel Sarhill

Research Symposium

Background: Autoimmune pancreatitis (AIP), an IgG4-related disorder, is a rare condition that typically presents as obstructive jaundice and pancreatic enlargement in older adults mimicking the manifestations of pancreatobiliary malignancies. Although the diagnosis of AIP has improved through growing awareness and proposed diagnostic criteria, differentiating between AIP and pancreatic cancer remains challenging.

Case Presentation: A 69-year-old Hispanic male presented with a 1-month history of nausea, epigastric pain, jaundice, and 20-pound weight loss. His medical history revealed type 2 diabetes. Physical exam showed scleral icterus, and laboratory results demonstrated an ALT of 412, AST 404, alkaline phosphate 501, total bilirubin 7.5, direct …

The Great Mimicker. A Case Of Gastrointestinal Tuberculosis., Grecia Dominguez Rivera, Jose Roberto Flores Gonzalez

Research Symposium

Background: Gastrointestinal (GI) tuberculosis (TB) is rare, accounting for 1-3 % of all TB cases worldwide. Mycobacteria enter the GI tract via hematogenous spread from active pulmonary TB, swallowing infected sputum, or ingesting contaminated food. The ileocecal area is most affected; however, tuberculous enteritis can involve any part of the GI tract. The vague clinical presentation makes the diagnosis challenging and often delayed requiring a high index of suspicion.

Case Presentation: A 28-year-old female who emigrated to the US from Mexico presented to the ED with a 4-month history of abdominal pain, vomiting, diarrhea, anorexia, 40-pound weight loss, intermittent fever, …

Sacral Pain "Recurrence" Not Exactly The Teenage Dream, Evan D. Perez

Research Symposium

Background: This case is a great example of remembering the basics. We teach our medical students, residents and fellows the importance of getting a thorough history and exam. However, this case is a reminder to apply those lessons in the real world.

Case Presentation: 15 yo Female came in complaining of sacral pain. 2 years prior she had a fall causing a coccyx fracture which resolved with conservative treatment. She didn’t have any issues since then until 3 weeks prior to today when she began to have pain in the same area. She denied any new inciting events such as …

Exacerbation Of Acute Angle Closure Glaucoma Symptoms Following Ssri Use, Elizabeth Althaus, Pamela Campos, Shuaibahmed M. Arab, Sidney Selva, Ryan Bialaszewski, Chelsea Chang

Research Symposium

Introduction: General Anxiety Disorder (GAD) is a relatively common disorder in the United States, which affects 6.8 million Americans. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are considered the mainstay of pharmacologic treatment of GAD, along with behavioral modifications, such as Cognitive Behavioral Therapy (CBT). However, these medications may cause harmful side effects in unique individuals. This abstract will discuss the unusual side effect of acute angle closure glaucoma in a male while being treated for GAD with an SSRI.

Case Presentation: The patient is a 60-year-old male with a history of diabetes mellitus, chronic kidney disease, …

Spindle-Cell Mesothelioma Arising From The Right Pleura: A Case Report And Review Of The Literature, Duc Khiem Ngo, Karina Torres, Sobia Hassan Memon, Carlos T. Ramos Jr.

Research Symposium

Background: Spindle cell mesothelioma, or Sarcomatoid mesothelioma, is a rare and insidious type of malignant mesothelioma with a high mortality rate. It arises from mesothelial surfaces of the pleural cavity, peritoneal cavity, tunica vaginalis, or pericardium, and it is usually associated with asbestos exposure. Spindle cell mesothelioma could be challenging to treat because most patients have advanced disease at presentation with an average prognosis of six months. In this case report we present a rare case of spindle-cell mesothelioma arising from the right pleura.

Case presentation: An 82-year-old male with a history of atrial fibrillation and coronary artery disease, status …

Delayed Management Of Pfo After Stroke Presentation In A Healthy Hispanic Female, Diana Othon Martinez, Barbara Malaga-Espinoza, Nestor Gerardo Astorga, Vamsikalayan Borra, Roque Mifuji

Research Symposium

Background: Strokes are a leading cause of long term disability. Around 800,000 people in the USA have a stroke every year. (CDC) 25% of the population have a Patent foramen ovale (PFO). Stroke in the presence of PFO has been described to be found in up to 40% of patients with “embolic stroke of undetermined source”, otherwise known as cryptogenic strokes. Despite the aforementioned prevalence, there is mixed data on PFO management options. Current management guidelines include dual anti-platelet therapy, anticoagulants, and percutaneous transcatheter closure. Some studies suggest that PFO might be an incidental finding in patients with cryptogenic stroke. …

Unmasking The Chameleon: A Rare Case Of Generalized Bullous Fixed Drug Eruption, Christopher Reid-Gordon, Aishwarya Gatiganti, Jose E. Campo Maldonado

Research Symposium

Background: Fixed drug eruption (FDE) is a unique dermatological drug reaction known for its recurrence in identical locations upon re-exposure to the causal drug. Acute FDE typically manifests a single or a small number of dusky red or violaceous plaques that, once resolved, leave post-inflammatory hyperpigmentation.

The case we present involves a patient with maculopapular bullous rash on his back, chest, and extremities. The rash was initially misdiagnosed as Chickenpox, yet a skin biopsy indicated Bullous Drug Eruption as a more likely diagnosis. This case is novel as the patient’s medical history did not reveal any previous intake of drugs …

Dual V2 And V3 Peripheral Pulsed Radiofrequency Ablation For Successful Trigeminal Neuralgia Treatment: A Case Report, Changho Yi, Justin Faye

Research Symposium

Introduction: Radiofrequency ablation is a common treatment for trigeminal neuralgia when medical treatment has failed, as it has been shown to be comparably effective to surgery with a better complication profile¹ . The elderly population, who are at a high risk for surgery, is a good candidate for this treatment. Currently, semilunar ganglion radiofrequency ablation (GRF) is the widely used approach² ; however, recently, peripheral radiofrequency ablation (PRF) of the V2 and V3 branches has been reported with comparable results³.

Objectives: To report a case of trigeminal neuralgia that was successfully treated with dual V2 and …