Internal Medicine Commons^™

Marathon Miles And Melena: Unmasking Acute Gastrointestinal Bleeding In An Endurance Athlete, Usman Bin Hameed, Mujtaba Moazzam, Nathanial Bartosek, Fady Banno, Naveen Reddy

Conference Presentation Abstracts

Gastrointestinal bleeding (GIB) is a recognized complication of endurance sports, particularly long-distance running. While most cases are mild and self-limited, studies indicate that up to 12% of ultramarathon participants experience occult bleeding. Severe or life-threatening GIB, such as ischemic colitis requiring surgery, has been reported but remains rare. Despite its potential significance, exercise-induced GIB remains poorly understood, with limited organized data on its prevalence and mechanisms. A 38-year-old male presented with a three-day history of melena following a recent marathon. Symptoms began with loose stools, progressing to tarry stools, accompanied by fatigue, exertional dyspnea, dizziness, and mild generalized abdominal discomfort. …

Real-World Clinical Burden Of Patients Presenting With Vaginitis Symptoms In The United States, Justin Chen, Jenny Tse, Liucheng Shi, Mindy M. Cheng, Rebecca Lillis, Aimee M. Near

School of Medicine Faculty Publications

Background: While vaginitis is a leading cause of primary care visits among women with a gynecologic-related diagnosis, there are limited contemporary data on the healthcare burden. This study describes the real-world healthcare resource utilization (HCRU) of patients presenting with vaginitis symptoms in the United States (US) at symptom presentation and over long-term follow-up. Methods: This retrospective study utilized IQVIA's Longitudinal Prescription (LRx) and Medical Claims (Dx) databases to capture patients presenting with vaginitis symptoms from January 1, 2018 to September 30, 2022. The date of the first diagnosis code for vaginitis or related symptoms was considered the first clinical presentation …

A Rare Case Of Lenalidomide Associated B Cell Lymphoblastic Leukemia, Yagnapriya Ammakola, Nitya Batra, Ashbita Pokharel, Ishmael Jaiyesimi

Conference Presentation Abstracts

Introduction Autologous stem cell transplantation followed by maintenance with Lenalidomide has improved the overall survival and progression free survival in patients with Multiple Myeloma. However, maintenance therapy with Lenalidomide can increase the risk of several hematological adverse events including secondary B cell lymphoblastic leukemia. We present a case of 61 year old female who was previously treated for multiple myeloma and on maintenance Lenalidomide developed B lymphoblastic leukemia/lymphoma. Case presentation A 61 year old female initially presented with left sided hip pain and lower back pain in 2018.Chest X ray revealed mass like opacity in the left upper lobe and …

A Complex Case Of Tracheoesophageal Fistula Following Chemoradiation And Esophagectomy, Mujtaba Moazzam, Usman Bin Hameed, Fady Banno, Rocco Sbrocca, Ramona M. Berghea

Conference Presentation Abstracts

Tracheoesophageal fistula (TEF) is a pathological connection between the trachea and esophagus. It is a rare but serious complication following esophagectomy, particularly in patients who have undergone concurrent radiation therapy, with rates of 5-15%. TEFs often manifest with severe complications such as malnutrition, infections, and life-threatening bleeding, making them exceptionally difficult to manage. This case report highlights a rare presentation of TEF in a patient with esophageal adenocarcinoma treated with multimodal therapy. A 45-year-old male with stage III esophageal adenocarcinoma underwent concurrent chemoradiation, esophagectomy, and immunotherapy. Subsequent oligometastatic disease required further treatment, including radiofrequency ablation and Keytruda maintenance. The patient …

A Case Of Orbital Apex Syndrome And Mucormycosis In Undiagnosed Diabetes, Basant Sanad, Deena Sukhon, Merzia Subhan, Mamon Tahhan

Conference Presentation Abstracts

Latent Autoimmune Diabetes in Adults (LADA) is a slowly progressive and indolent condition often characterized by nonspecific symptoms at onset, which can result in delayed diagnosis and the development of severe complications. We report a case presenting with HHS/DKA, left orbital apex syndrome due to invasive fungal sinusitis, and multiple neuropathies. Despite aggressive surgical debridement, antifungal therapy, and ongoing ophthalmologic monitoring, he remains at risk for further complications, including potential orbital exenteration. A 45-year old male who has not sought medical care in the past 20 years and has no significant past medical history presented with progressive bilateral leg pain …

Profound Endocarditis Resulting In Recurrent Fatigue, Shawn Matharu, Majid Qazi

Conference Presentation Abstracts

A 46 year-old female with past medical history of congenital aortic stenosis status post bovine bioprosthetic valve replacement and an ascending aortic aneurysm repair 13 years prior to presentation presented with fatigue and generalized weakness. The patient also had a history of non-obstructive coronary artery disease, hypertension, and HFpEF. She recently was diagnosed with infectious mononucleosis 3 weeks prior. In the 1 month prior to her index presentation she had two prior admissions for respiratory symptoms. On physical exam, the patient had a 4/6 holosystolic murmur. Her laboratory markers revealed a profound leukocytosis, mild anemia, a mild troponinemia, hypokalemia, and …

Coronary Subclavian Steal Syndrome: A Rare But Deadly Complication In Post-Cabg Patients, Hazem Alakhras, Parvathy Sankar, James Goldstein

Conference Presentation Abstracts

Coronary Subclavian Steal Syndrome (CSSS) is a rare but serious complication of coronary artery bypass grafting (CABG). It occurs when the left anterior descending (LAD) coronary artery is bypassed from the left subclavian artery (LSA) using the left internal mammary artery (LIMA). The syndrome arises due to stenosis of the LSA, leading to reduced blood flow through the LIMA. This triggers retrograde flow from the LIMA to the distal LSA, resulting in myocardial ischemia despite patent grafts. Clinical presentation can vary from asymptomatic cases to severe manifestations such as new-onset heart failure or acute coronary syndrome (ACS). A 79-year-old female …

Double Trouble: A Case Of Persistent Left-Sided Superior Vena Cava, Lark Steafo, Kateryna Strubchevska, Olena Strubchevska, Marko Kozyk, Shazil Mahmood, Steven Timmis

Conference Presentation Abstracts

A persistent left-sided superior vena cava (PLSVC) is a rare vascular anomaly where the left superior cardinal vein fails to regress during embryogenesis, resulting in an additional venous structure that drains into the right atrium, often via the coronary sinus. It is usually asymptomatic but may be discovered incidentally during imaging or procedures, but its presence can have implications for central venous access and pacemaker placement. Our case features an 82-year-old male with a past medical history of coronary artery disease, remote esophageal cancer, hypertension, hyperlipidemia, and tobacco use disorder, referred to the emergency department from his primary care doctor’s …

Case Of Coxsackie B Perimyocarditis Presenting With Hemoptysis, Respiratory Failure, And New-Onset Heart Failure, Maya Jaradi, Nicole Marijanovich

Conference Presentation Abstracts

Perimyocarditis describes inflammation of the pericardium and myocardium. Most cases are idiopathic, however when infectious causes are present, it is typically due to a virus such as coxsackievirus, adenovirus, herpesvirus, or echovirus amongst others. Clinical features vary from mild, self-limiting symptoms to cardiogenic shock and death. We will discuss a unique case of viral perimyocarditis presenting with hemoptysis, respiratory failure, and new-onset heart failure with severely reduced ejection fraction. A 59-year-old female with a history of asthma, hypertension, and recently treated pneumonia presented with acute-onset headache, fatigue, and shortness of breath. On admission, she was severely hypertensive in the 200s/90s. …

Hypereosinophilic Syndrome In A Patient With Diffuse B-Cell Lymphoma, Keaton Schmitz, Francisco R. Davila, Aagamjit Singh, Jamie Satow

Conference Presentation Abstracts

Introduction Hypereosinophilic syndrome (HES) is a rare condition characterized by eosinophil-mediated organ damage and a peripheral eosinophil count >1.5x10⁹/L, with varied etiologies classified as primary, secondary, idiopathic, or organ-restricted. Cardiac involvement, often termed Loeffler’s endocarditis (LE), is a rare but severe manifestation of HES. Neoplastic causes of HES are typically linked to myeloid neoplasms, with limited literature on an association with B-cell lymphomas. We report a unique case of HES and LE in a patient with diffuse large B-cell lymphoma (DLBCL). Case description A 78-year-old female with a past medical history of DLBCL, coronary artery disease, and cryptogenic strokes presented …

Efficacy Of Neuromuscular Ultrasound In Diagnosing And Treating A Mammogram-Induced Brachial Plexus Injury-A Case Report, Jaime Dougherty, Tyler Pigott, Altamash E Raja

Rowan-Virtua School of Osteopathic Medicine Departmental Research

A 40-year-old woman presented with chronic left anterior shoulder, upper arm, and axillary pain following a routine mammogram 3 years prior. Despite multiple interventions, her pain persisted significantly affecting her quality of life. Ultrasound examination revealed fascicular edema in the medial brachial cutaneous nerve (MBCN), intercostobrachial cutaneous nerve (ICBN), and a positive sono-Tinel. Ultrasound-guided hydrodissection of these nerves provided complete axillary pain relief and significant improvement in anterior arm pain, sustained for 6 months. This case highlights the diagnostic challenges of cutaneous nerve entrapment syndromes, often overlooked and misdiagnosed, especially without a clear inciting injury. Ultrasound proves superior to electrodiagnostic …

Early Celiac Plexus Block In Metastatic Pancreatic Cancer, Brian Fardman, Christina Sheedy, Joshua Raymond

Rowan-Virtua Research Day

Both Early and Delayed Celiac Plexus Blocks (CPBs) have been used in pancreatic cancer. Early CPB is completed when criteria for CPB is initially met, whereas Delayed CPB is implemented only after recalcitrant pain persists. We describe the benefit of early CPB in pancreatic cancer management.

Associations Between Health Literacy And Comprehension Of Health Visits In A Community Setting, Amanda Romaya, Adel Andemeskel, Salim Abdul-Razak, Linda Dillon, Victoria Lucia

Posters

Low health literacy is a significant social determinant of health that is associated with poor health outcomes1-3. Bringing attention to health literacy will aid in promoting the health of the population. However little has been done to implement national policies and interventions that address patient health literacy, especially in a community setting4.

We hypothesized that our assessment of the identified patient population’s health literacy will not meet adequate standards and will indeed demonstrate a need for community-focused interventions

An Analysis On Gender And Race For Burnout Among Michigan Internists, Elan Pszenica, Jookta Basu, Esha Ahmed, Hugo Davila

Posters

Burnout among physicians, particularly in the field of internal medicine, has become a significant concern in recent years. This condition is characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, which can have detrimental effects on both healthcare providers and patient care. 1 While burnout is a recognized issue globally, its impact on internal medicine physicians in Michigan has not been comprehensively studied. Understanding the unique stressors faced by these physicians is critical for developing targeted interventions to reduce burnout rates and improve the overall healthcare environment. Internal medicine physicians often face intense workloads, long hours, administrative …

The Impact Of Physician Vaccine Recommendation On The Pregnant Chaldean Population, Sylvia Kashat, Nelia Afonso

Posters

• A variety of factors contribute to modern vaccine hesitancy, including balancing the risks and benefits of vaccination and delayed negative outcomes. • An important population to consider are pregnant women and their fetus, as the immune compromised state may increase the burden of disease. • It is the duty of healthcare providers to properly educate mothers on the effectiveness of vaccination on vaccinetreatable and vaccine-preventable diseases. • A subgroup that has been impacted by this greatly in the metro-Detroit area is the Chaldean community. • With the Michigan Chaldean population being greater than 160,000, and most of the community …

Outcomes Of Left Atrial Appendage Occlusion In Patients With Obstructive Sleep Apnea: A Comprehensive National Study, Tony Elias, Fady Beshara, Daniel Basta, Mena Elmalh, Matthew Ebrahim, Taha Syed, Olga Sarah, Abdallah Hussein

Rowan-Virtua Research Day

We sought to explore a sample of the inpatient population with OSA with AF who underwent LAAO.

Autoimmune Encephalitis Presenting As Pseudodementia (Case Report), Renita Ng, Christie Richardson

Rowan-Virtua Research Day

Patients with autoimmune encephalitis frequently present with psychiatric symptoms including psychosis, behavioral changes, and affective disorders. Because of this, misdiagnosis of a primary psychiatric disorder in a case of autoimmune encephalitis is not uncommon. We present a case of autoimmune encephalitis in a 72 year old who was initially thought to have psuedodementia or catatonia due to variable collateral who later on LP was found to have markers and responded to steroid treatment. This case highlights the importance of maintaining a broad differential with patients who present with psychiatric alterations and to consider other causes of behavioral change.

Clinical Outcomes For Smokers With Early-Onset Colorectal Cancer: An Analysis Of The National Inpatient Sample, Matthew Ebrahim, Tony Elias, Sonika Vatsa, Yarin Trabelsi, Kyrillos Girgis, Taha Syed, Rafail Beshai

Rowan-Virtua Research Day

We sought to examine the national inpatient sample database to describe in-hospital outcomes among smokers with EOCRC. The NIS was searched for hospitalizations of adult patients with EOCRC, defined as all-cause colorectal cancer in patients 50 years old or younger. In this nationally representative population‐based retrospective cohort study, hyperlipidemia was associated with higher mortality.

Case Report: A Case Of Tracheal Perforation, Cyrus Davati, Eric Maddock

Rowan-Virtua Research Day

Here we present the case of a 93-year-old female with a past medical history of arthritis and dementia who came to the hospital for a change in mental status and decreased responsiveness at home. The patient was intubated at home by EMS secondary to continued respiratory distress. The patient had a history of a productive cough over the past three days. The patient arrived at the emergency department with continued respiratory failure. During the ED evaluation, the patient was noted to have tracheal rupture. The patient was admitted to the ICU for severe sepsis and continued on broad spectrum IV …

Exploring Anticoagulant Prescription Disparities: A Focus On Hispanic Patient Care, Michael Acevedo, Vanessa Veltre

Rowan-Virtua Research Day

Anticoagulants play a critical role in preventing thromboembolic events, yet disparities persist in their prescription among minority populations. This presentation explores inequities in anticoagulant prescribing patterns, with a specific focus on Hispanic patient care. Using retrospective electronic health record data, we analyzed the prescription rates of warfarin versus direct oral anticoagulants (DOACs) among adults with clinical indications for anticoagulation. Our findings reveal that Hispanic patients are significantly less likely to receive DOACs compared to non-Hispanic White patients, even after adjusting for demographics, comorbidities, and insurance status. Contributing factors include language barriers, lack of insurance, and potential implicit bias in provider …