Immune System Diseases Commons^™

Delayed Diagnosis Of Systemic Lupus Erythematosus Presenting As Autoimmune Hemolytic Anemia: A Case For Heightened Clinical Suspicion, Diana Acosta Pozo, Luis Álvarez Pérez

Research Colloquium

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement, including hematologic manifestations. Autoimmune Hemolytic Anemia (AIHA), though an established feature, is relatively uncommon and may occur early or in isolation. When AIHA presents without overt systemic symptoms, the underlying autoimmune etiology may be overlooked, resulting in delays in diagnosis and treatment. Prompt recognition is essential to prevent unnecessary interventions and prolonged morbidity.

Case Presentation: A 39-year-old woman residing in Texas presented to the Rheumatology office with persistent synovitis and severe transfusion-dependent anemia, requiring red blood cell transfusions every 48 hours for over three months. She …

Il-17a Immune Signature Across Stratified Stages Of Type 2 Diabetes​, Brittney C. White, Antonio Hernandes Chaves-Neto, Peter Elvin, Javier La Fontaine, Eric L. Brown, Walid Fakhouri, Craig Hanis, Claudia Biguetti

School of Podiatric Medicine - Student Research

Purpose: This study investigated whether IL-17A, a pro-inflammatory cytokine associated with Th17 cell activity, reflects distinct stages of type 2 diabetes progression.

Methods: Forty-two obese individuals (average age: 60.4 ± 10.3 years; 55% male; BMI: 31.3 ± 4.9) from Starr County, Texas, were matched for gender and BMI and stratified into five metabolic groups based on fasting blood glucose, 2-hour oral glucose tolerance test, and HbA1c levels. Groups included diabetes-free, isolated impaired glucose tolerance, combined glucose impairment, diabetes without complications, and diabetes with lower extremity complications. IL-17A protein levels were quantified from buffy coat samples using ELISA. After excluding …

The Impact Of Covid 19 Infection On Graves' Disease, Shadi Jafari-Esfahani, Semenawit B. Burka, Edwardo D. Luna

Research Colloquium

Background: Although there are not many studies regarding the effects of Covid-19 infection on Graves’ disease, few case reports demonstrate the association between the two. The SARS-CoV-2 uses the angiotensin II converting enzyme to gain entry into cells. This results in hyperactive immune response involving Th1 and Th17 lymphocytes which activates proinflammatory cytokines; IL-6 and TNF-alpha. Research shows elevation of IL-6 in patients with Graves’ disease.

Case report: A 22 years old man with no past medical history presented to the Emergency Room for the complaint of generalized weakness and dyspnea of one day. He had associated dry cough, palpitations, …

Progressive Multifocal Leukoencephalopathy (Pml) Induced By Jc Virus: A Case Report And Review Of Clinical Implications, Hugo Zamarron, Roberto Cruz

Research Symposium

Background: Progressive multifocal leukoencephalopathy (PML) is a rare but serious demyelinating disease of the central nervous system, caused by the John Cunningham (JC) virus. While the JC virus is common in the general population, it remains dormant in healthy individuals but can reactivate in immunocompromised patients, particularly those with HIV/AIDS or undergoing immunosuppressive treatments for organ transplants or autoimmune conditions. The virus attacks oligodendrocytes, leading to demyelination and significant neurological deficits. Immunosuppressive therapies such as natalizumab, rituximab, and mycophenolate increase the risk of PML. Diagnosing PML is challenging as its symptoms—focal neurological deficits, sensory-motor issues, and visual disturbances—overlap with conditions …

Long-Term Safety And Comparative Efficacy Of Il-17 Inhibitors In Treating Ankylosing Spondylitis, Alyssa L. Sepulveda, Yolanda V. Gutierrez, Ronald A. Shaju

Research Symposium

Background:
Ankylosing Spondylitis (AS) is a chronic inflammatory disease affecting the axial skeleton, characterized by spinal stiffness, sacroiliitis, and potential vertebral fusion. While nonsteroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor (TNF) inhibitors are first-line treatments, IL-17 inhibitors, such as secukinumab and ixekizumab, are used in patients with inadequate response or contraindications to TNF inhibitors. These targeted therapies address IL-17’s role in driving inflammation and structural damage in AS.

Methods:
A systematic review was conducted using PubMed, Science Direct, and Cochrane to identify studies published between 2000 and 2025. Keywords included “Ankylosing spondylitis” and “IL-17 inhibitors” and “efficacy.” Inclusion criteria …

The Impact Of Electronic Messaging On Hiv In A Medically Underserved Population, Blake Martin, Smaran Marupudi, Justin Heckman, Russell Wiggins

Research Colloquium

Introduction: HIV in the United States has affected all types of demographics and has been growing by 50,000 new infections each year. Healthy people 2030 states that their objectives of both reducing new HIV cases and increasing knowledge of the disease has had little to no change. We intend to decrease both short-term incidence of HIV contracture and long-term incidence of disease progression to AIDS via utilization of an electronic health messaging and outreach system.

Methods: Individuals will be registered for text alerts at their next AHEC medical appointment. The practitioner, utilizing an HIV Risk Assessment Tool would ask high-risk …

Prognostic Utility Of The Lactate/Pyruvate Ratio For Mortality In Patients With Sepsis: An Observational Study, Edgar G. Dorsey-Trevino, Olga G. Cantu-Rodriguez, Jose A. Hawing-Zarate, Grecia A. Gonzalez-Cantu, David Gomez-Almaguer, Cesar H. Gutierrez-Aguirre

Research Colloquium

Introduction: Measurement of serum lactate remains pivotal in sepsis evaluation as it is closely related to tissue hypoxia and mortality.^{1, 2} Serum lactate, however, can be elevated due to a myriad of reasons beyond hypoperfusion.³ A proposed alternative to control for serum lactate’s inherent variability is to measure pyruvate concomitantly to calculate the lactate/pyruvate (L/P) ratio.^{4, 5} As pyruvate transforms into lactate in anaerobic conditions, its value decreases in serum, increasing the L/P ratio, hence indicating an actual tissue-perfusion mismatch.⁶ Despite its clinical utility, there is a paucity of evidence evaluating the role of the L/P …

A Presentation Of Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease (Mogad) As Optic Neuritis, Kirhyn A. Stein, Laura Garcia, Sobia Memon, Hernan Guanajuato, Johanna Mora

Research Colloquium

Background: Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease (MOGAD) is a relatively new and rare autoimmune disease that causes demyelination of the central nervous system. The pathogenicity of this disease is characterized by an immune reaction against myelin oligodendrocyte glycoprotein: a component of the myelin sheath that is also expressed on the surface of oligodendrocytes. The purpose of this glycoprotein is thought to be for construction and maintenance of myelin and cell to cell communication. The destruction of oligodendrocytes and myelin in the central nervous system affects the brain, spinal cord, and optic nerves, and can cause symptoms such as acute …

Examining The Matrix: A Case Of Anti-Nuclear Matrix Protein 2 (Nxp-2) Positive Dermatomyositis, Victoria Cuello, Ramiro Oquita, Emilia Dulgheru

Research Symposium

Background: Dermatomyositis is a disease characterized by proximal muscle weakness, elevated muscle enzymes and cutaneous skin findings including heliotrope rash, periungual erythema, Gottron’s papules/sign and shawl-sign. Myositis-specific autoantibodies (MSA) can be used to predict disease manifestations, response to therapy and prognosis. Specifically, patients with dermatomyositis with positive anti-nuclear matrix protein (NXP-2) typically present with classical skin findings, subcutaneous edema, profound muscle weakness, severe dysphagia and hypophonia.

Case Presentation: A 21-year-old Hispanic lady presented to the hospital for severe muscle weakness. She reported soreness in her thighs for three months prior to presentation followed by arm soreness. She also developed a …

A True Bloody Emergency: An Unusual Case Of Thrombotic Thrombocytopenic Purpura, Joshua M. Ninan

Research Symposium

Background: Thrombotic thrombocytopenic purpura (TTP) is a primary thrombotic microangiopathy that is classically characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA). Although rare with an annual incidence of 3.7 cases per one million adults, it is considered a true hematological emergency due to its fatality rate of almost 100% if appropriate treatment is not initiated immediately. This makes it vitally important to identify and treat patients with TTP, a task that becomes unusually challenging in the absence of the disorder’s other characteristically diagnostic clinical features such as mucosal bleeding, fever, or presence of schistocytes.

Case Presentation: A 30-year-old gentleman with …

Multisystem Inflammatory Syndrome In Children (Mis-C): Is There A Relationship To Typhus?, Sravani Mannuru, Juliana Hager, Jacob Smith

Research Colloquium

The United Kingdom first reported in April 2020 a group of eight previously healthy children with a link to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that presented with systemic inflammation and multi-organ involvement, now named multisystem inflammatory syndrome in children (MIS-C). The Centers of Disease Control and Prevention (CDC) have reported over 1000 cases since the primary discovery as of October 2020 with 20 total deaths. [1] The clinical features of MIS-C have been previously compared to inflammatory syndromes including Kawasaki disease (KD) and toxic shock syndrome (TSS). We describe the clinical presentation and management for 3 pediatric cases with …

A Very Di-Still-Ed Diagnosis- Adult-Onset Still’S Disease Presenting In A Middle-Aged Hispanic Patient, Christine E. Loftis, Juan Naranjo, Shadi Jafari-Esfahani, Andrew Guerra, Emilia C. Dulgheru

Research Symposium

Background: Adult-Onset Still’s Disease (AOSD) is a systemic inflammatory disorder characterized by daily high fevers, arthritis, evanescent rash, and leukocytosis (1). Patients can present without typical manifestations and pose a challenging differential. We present a case of a 52-year-old gentleman with a one-year history of recurring fever, lymphadenopathy, and weight loss diagnosed with AOSD. This case highlights the diagnostic challenge that AOSD poses and the strategies to help aid in the diagnosis.

Case Presentation: A 52-year-old gentleman presented to the ED for a 2-week history of fever associated with chills and bone pain. He reported that he has been having …

The Importance Of A Broad Differential Diagnosis: Hepatitis C Virus Associated Cryoglobulinemic Vasculitis, Shadi Jafari-Esfahani, Christine E. Loftis, Juan Naranjo, Emilia Dulgheru

Research Symposium

Introduction: Mixed cryoglobulinemia syndrome (MCS) is a systemic inflammatory syndrome affecting small-medium sized vessels due to the presence of type II or III cryoglobulins in the serum. MSC can manifest as systemic vasculitis with symptoms varying from weakness, arthralgia, palpable purpura, peripheral neuropathy, and renal involvement. The most common cause of MCS includes lymphoproliferative disorders, autoimmune diseases and viral infections, with hepatitis C virus (HCV) being the most common etiology.

Case Presentation: A 60-year-old lady was referred to our office for evaluation of rheumatoid arthritis. She reported history of bilateral thumb pain, bilateral knee pain associated with episodes of swelling, …

Granulomatous Mastitis: A Rare Or An Underdiagnosed Disease?, Shadi Jafari-Esfahani, Juan Naranjo, Christine E. Loftis, Emilia Dulgheru

Research Symposium

Introduction:Granulomatous mastitis (GM) is a benign chronic inflammatory breast disease that is poorly understood, with no universal agreement on underlying etiologies and treatment protocol. The proposed etiologies include trauma, metabolic processes, hormonal changes, autoimmune disorders, and infections. This entity commonly presents with unilateral painful firm and erythematous breast mass, and less frequently with areolar retraction, fistula formation and ulceration. The disease is more common in Hispanic and Asian population. Due to its inflammatory nature, the mainstay of treatment includes a tapered course of high-dose corticosteroid, and methotrexate has proven to be effective in some cases.

Case Presentation: A 47-year-old …

Clinical Characteristics And Risk Factors For Mortality During The 'First Wave' Of Covid-19 In Reynosa, Tamaulipas, Luis G. Vargas Garcia, Francisco E. Díaz Cisneros, Antonio Gutiérrez Sierra, Juan Rosales Martínez, Manlio F. Lara Duck, Netzahualcoyotl Mayek Pérez

Research Symposium

Background: The COVID-19 pandemic has impacted public health in Mexico. As of February 2020, there have been at least four "waves" of contagion that resulted in 5.82 million positive cases and more than 325 thousand deaths. At the beginning of the COVID-19 pandemic, hospital and population-based information was available, frequently with non-specific symptoms. Little was known about the risk factors for mortality in specific conditions. We described the clinical characteristics of patients with COVID-19 in Reynosa, Tamaulipas during 2020 and identified the risk factors for mortality.

Methods: The COVID-19 cases registered from March to November 2020 in Reynosa were divided …

Acute Eosinophilic Pneumonia In A Patient With Long Standing Behcet’S Syndrome, Juan C. Naranjo, Shadi J. Estefahani, Christine E. Loftis, Emilia Dulgheru

Research Symposium

Background: Behcet’s syndrome (BS) is a multisystemic disease that frequently manifests as oral and genital ulcers. Pulmonary involvement occurs in approximately 18% of patients and can have complex clinical manifestations, including vascular disease, hemorrhage, infarctions, and organizing pneumonia. Broad-spectrum radiological findings like loss of lung volume, lung opacities, and indistinct nodular or reticular lesions have been described. There is little data on the association between Behcet’s disease and eosinophilic pneumonitis; the latest is usually characterized by eosinophilic infiltration of the lung parenchyma caused by a hypersensitivity reaction to an inhaled antigen. Patients usually present with nonproductive cough, dyspnea, fever, and …

That Which Keeps On Giving - A Case Of Class Iv Diffuse Proliferative Lupus Nephritis In A Hispanic Woman With Underlying Systemic Lupus Erythematosus, Josenny L. Rodriguez-Paez, Christine E. Loftis, Rosa White-Guedez

Research Symposium

Background: Glomerulonephritis is the primary cause of morbidity and mortality of systemic lupus erythematosus (SLE). Lupus nephritis is characterized by immune complex deposition in the mesangium leading to complement activation and hypocomplementemia. Studies show that up to 60% of adults with lupus develop renal involvement and it has been well established that Hispanic patients show poorer outcomes than Caucasians despite advances in treatment. Preserved kidney function with new-onset proteinuria should raise clinical suspicion for acute lupus nephritis. Further evaluation with a kidney biopsy is paramount in establishing a diagnosis, helping to define treatment strategy, and determining response to treatment.

Case …

Another One Bites The Joint: A Case Of Reactive Arthritis In An Otherwise Healthy Hispanic Male, Christine E. Loftis, Emilia C. Dulgheru

School of Medicine Publications

Reactive Arthritis is a spondyloarthritis following gastrointestinal or genitourinary infections, traditionally described as a triad of conjunctivitis, urethritis, and arthritis. It is important to identify patients with reactive arthritis as certain disease features portend a poorer prognosis. We present a case of reactive arthritis in a 36-year-old gentleman after a self-limited episode of gastroenteritis.

A 36-year-old man presented to the Rheumatology clinic for a 2-week history of multiple arthralgias. The patient reported that one week before the onset of arthritis he experienced a self-limited episode of gastroenteritis. Succeeding, the patient noticed pain and swelling to right wrist, left elbow, and …