J-LSMS | Abstracts | 2022

J-LSMS | Abstracts | 2022

ABSTRACTS FROM THE 2022 LOUISIANA ANNUAL ACP MEETING

CONTENTS

JOURNAL EDITORIAL STAFF

ASSOCIATE EDITOR L.W. Johnson, MD

CHIEF EXECUTIVE OFFICER Jeff Williams

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RESIDENT ABSTRACTS

JOURNAL EDITORIAL BOARD Vice Chair, K. Barton Farris, MD Secretary/Treasurer, Richard Paddock, MD

5 BILATERAL THALAMIC GLIOBLASTOMA MULTIFORME PRESENTING WITH APHASIA 6 SEVERE NONCIRRHOTIC HYPERAMMONEMIA: WHAT UREA-LLY SHOULD CONSIDER 7 MASQUERADING AS TTP: AN INSIDIOUS PRESENTATION OF B12 DEFICIENCY 8 LEUKEMIA CUTIS: AN UNCOMMON PRESENTATION OF ACUTE MYELOID LEUKEMIA 9 ANORECTAL MUCOSAL MELANOMA: A RARE BUT POTENTIALLY FATAL CAUSE OF RECTAL BLEEDING 10 KSHV INFLAMMATORY CYTOKINE SYNDROME (KICS) 11 A PRESING NEUROLOGIC SEQUELA OF COVID-19 INFECTION 12 CNS NOCARDIOSIS IN AIDS PATIENT 13 A CURIOUS CASE OF THE “POX” STROKE 14 HERPETIC COLITIS CAUSING LOWER GI BLEEDING IN A PATIENT UNDERGOING CHEMOTHERAPY 15 A CURIOUS CASE OF MEIGS-LIKE SYNDROME 16 SYSTEMIC LUPUS ERYTHEMATOUS AS A MIMICKER OF LYMPHOPROLIFERATIVE DISEASE 17 AN OMINOUS PRESENTATION OF STAPHYLOCOCCUS HOMINIS 18 A CURIOUS CASE OF SPONTANEOUS WATERHOUSE-FRIDERICHSEN SYNDROME 19 PENILE CALCIPHYLAXIS 20 FUNGAL PETROCLIVAL OSTEOMYELITIS DUE TO ASPERGILLUS IN AN IMMUNOCOMPETENT PATIENT 21 REVERSE TAKUTSUBO CARDIOMYOPATHY ASSOCIATED WITH PHLEGMASIA CERULEA DOLENS 22 A CASE REPORT OF NEURO SARCOIDOSIS. 23 THE CROWN OF MISFORTUNE: A CASE OF AN UNDER- DIAGNOSED RHEUMATOLOGIC RARITY 24 DROOLING, STIFF, AND MUTE! 25 GLEICH SYNDROME 26 ADULT INTUSSUSCEPTION: FINDING A LEAD ON A RARE CASE 27 BREAST CANCER METASTASIS TO BONE MARROW, INITIALLY DIAGNOSED AS MYELOFIBROSIS 28 YOU DON'T WANT TO MISS THIS RASH 29 STUDENT ABSTRACTS 30 THE CURIOUS CASE OF NEUROMYELITIS OPTICA. 31 ADDRESSING DISRUPTIONS IN CARE: A STUDY OF CHRONIC DISEASE EXACERBATIONS IN AN UNDERSERVED COMMUNITY FOLLOWING HURRICANE IDA 32 DON’T| BE SO LITTORAL: FALSE-POSITIVE ECHINOCOCCUS ANTIBODY TESTING MASKS A CASE OF LITTORAL CELL ANGIOMA 33 INTERPRETING PATIENT PERCEPTION OF BANKART REPAIR VIA SOCIAL MEDIA 34 ASSESSING CLINICAL, DEMOGRAPHIC, AND EPIDEMIOLOGICAL VARIABLES AMONG THE FIRST 500 COVID-19 PATIENTS IN AN URBAN EMERGENCY DEPARTMENT 35 DETECTION OF LATENT AUTOIMMUNE DIABETES IN ADULTS IN A 40-YEAR-OLD WITH RHEUMATOID ARTHRITIS AND HASHIMOTO’S HYPOTHYROIDISM. 36 WONDERING ABOUT WUNDERLICH SYNDROME: A RARE CASE OF SPONTANEOUS RENAL HEMORRHAGE 37 OSMOTIC CENTRAL PONTINE DEMYELINATION SYNDROME IN A EUNATREMIC ELDERLY MAN 38 SWALLOW SYNCOPE ASSOCIATED WITH INTERMITTENT SINUS PAUSE AND HIGH DEGREE AV BLOCK 2

Anthony Blalock, MD D. Luke Glancy, MD L.W. Johnson, MD Fred A. Lopez, MD

LSMS 2021 BOARD OF GOVERNORS OFFICERS President, William Freeman, MD Past President, Katherine Williams, MD President-Elect, John Noble, Jr., MD Vice President, George Ellis, Jr., MD Speaker of the House, T. Steen Trawick, MD Vice Speaker, R. Reece Newsome, MD Secretary/Treasurer, Richard Paddock, MD Chair, COL, David Broussard, MD COUNCILORS District 1 Member, Myra Kleinpeter, MD District 1 Alternate, Maurice Sholas, MD District 2 Member, Robert Chugden, MD District 3 Member, Allen Vander, MD District 4 Member, Richard “Rick” Michael, MD District 5 Member, Gwenn Jackson, MD District 6 Member, Michael Roppolo, MD District 7 Member, Brian Gamborg, MD District 8 Member, Lance Templeton, MD District 9 Member, Andy Blalock, MD District 10 Member, Nicholas Viviano, MD District 10 Alternate, James Connolly, MD SECTION REPRESENTATIVES Senior Physician Member, Marcus Pittman, III, MD Senior Physician Alternate, Donnie Batie, MD Young Physician Member, Amberly Nunez, MD Resident/Fellow Member, Blake Denley, MD Medical Student Member, Brittany Wagner Employed Physician Member, Matt Giglia, MD Private Practice Physician Member, Vicki Steen, MD

Each year medical students from the five medical schools and residents from the eight Internal Medicine training programs in Louisiana are invited to submit abstracts for the Annual American College of Physicians (ACP) Resident and Student Meeting of the Louisiana Chapter. The content of these abstracts includes clinical case vignettes or research activities. The abstracts have all identifying features removed (i.e., names, institutional affiliations, etc.) before being sent to resident council judges. This year a total of 117 abstracts were submitted for the meeting. Each judge scores each abstract independently and then the scores from all judges are averaged and ranked. This year we are excited to be able to publish the most highly ranked resident (24) and student (9) abstracts presented at this year’s competition that were selected for oral presentations. All abstracts were presented at the Associates Meeting held virtually due to the COVID-19

pandemic on January 22, 2022. We would like to thank the Resident Council for helping score the top abstracts for presentation: Katherine Oakden, LSU New Orleans, Jacob Peoples, LSU Baton Rouge, Priyanka Patel, Chabert Medical Center, Chad Kaplan, Baton Rouge General, Paula Cacioppo, Ochsner Medical Center and Rebecca Prechter, LSU Lafayette. We would like to thank the Journal of the Louisiana State Medical Society and appreciate its efforts to publicize the hard work of these trainees.

Shane Sanne, DO, FACP Co-Chair , Louisiana Associates Liaison Committee

Miranda Mitchell, MD Co-Chair , Louisiana Associates Liaison Committee

Shahzeem Bhayani, MD Co-chair, Louisiana Student Liaison Committee

Catherine Hebert, MD, FACP Co-Chai r, Louisiana Student Liaison Committee

Angela Johnson, MD, FACP Governor, Louisiana Chapter ACP

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RESIDENT ABSTRACTS

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BILATERAL THALAMIC GLIOBLASTOMA MULTIFORME PRESENTING WITH APHASIA G Unis MD, E Philon DO Department of Medicine, Ochsner Medical Center, New Orleans, LA INTRODUCTION Bilateral thalamic lesions on brain Magnetic Resonance Imaging (MRI) represent a unique and unusual radiographic pattern. While unique, the differential for bilateral thalamic lesions is broad and can include cerebrovascular disease, toxin or metabolic syndromes, posterior reversible encephalopathy syndrome, viral infections, and neo- and paraneoplastic processes. CASE A 55-year-old male with hypertension and type 2 diabetes presented with an acute aphasia of 5 hours in duration and general malaise prior to admission but denied other significant symptoms. Physical examination at the time of admission was negative for neurological abnormalities including cranial nerve testing, as well as being fully alert and oriented with appropriate mentation. He was afebrile, slightly hypertensive with a blood pressure of 149/96, and without oxygen requirements. Laboratory studies were within normal limits on admission however, computed tomography of the head demonstrated subtle diminished density within the left thalamus. MRI imaging of the brain demonstrated bilateral thalamic enlargement with diffuse T2/FLAIR signal hyperintensity. Lumbar puncture was obtained and routine cerebral spinal fluid (CSF) studies in addition to viral, bacterial cultures, and autoimmune studies were ordered. The patient was found to be positive for West Nile Virus (WNV) but with a negative WNV polymerase chain reaction (PCR) and toxoplasmosis IgG positive results. The patient was treated empirically for toxoplasmosis but failed to improve. Repeat MRI was obtained and demonstrated new enhancement which prompted a brain biopsy of the temporal lobe. Pathology showed WHO Grade IV glioblastoma multiforme and the patient was referred to oncology. DISCUSSION This rare and unusual disease, while previously described in the literature highlights the broad differential for bilateral thalamic lesions found on brain MRI and represents a unique learning case.

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SEVERE NONCIRRHOTIC HYPERAMMONEMIA: WHAT UREA- LLY SHOULD CONSIDER S Wu, C Basilio MD, MPH Department of Medicine, Tulane Health Sciences Center, New Orleans, LA

INTRODUCTION Hyperammonemia is often the result of liver pathology. When hyperammonemia is not the result of liver disease, an occult disorder of metabolism must be on the differential for unexplained hyperammonemia, such as a urea cycle disorder.

CASE A 57-year-old man with recovered systolic heart failure, atrial fibrillation, hypertension, and cervical neck fracture status post recent cervical spine corpectomy and fusion presented with worsening dysphagia and neck discomfort and was found to have a cervical fluid collection. He had no known underlying liver disease and denied significant alcohol history. He received a dexamethasone taper and a lumbar drain. He was later admitted to the intensive care unit (ICU) for unstable atrial fibrillation with rapid ventricular rates. In the ICU, the patient became more somnolent and was unable to follow commands. Encephalopathy workup revealed elevated BUN with normal creatinine, ammonia of 772, and mildly elevated transaminases. Liver workup was normal. Workup for inborn errors of metabolism showed mildly decreased citrulline. Urine and plasma amino acids were otherwise normal. His hyperammonemia resolved and his mentation improved with lactulose three times daily and rifaximin twice daily. Urea cycle disorder gene panel and further genetic workup is ongoing. Patient will follow up with genetics after discharge. DISCUSSION Patients with elevations of ammonia present with encephalopathy, which may progress quickly to cerebral herniation. Survival requires immediate reduction of ammonia levels. Although the differential for hyperammonemia is broad, inborn errors of metabolism (IEM), like a urea cycle disorder, should be considered when hyperammonemia is of unclear etiology. Although IEMs often have early age of onset, urea cycle disorders have multiple modes of inheritance and can present at later stages. IEMs may also be unmasked by steroid therapy, which is plausible in this patient who was on a steroid taper prior to his hyperammonemic state. Treatment for a potential IEM begins prior to confirmation of an etiology. Geneticists should be consulted early on for evaluation and management.

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MASQUERADING AS TTP: AN INSIDIOUS PRESENTATION OF B12 DEFICIENCY M Zoya MD, M N Salloum MD Department of Medicine, Louisiana State University, Shreveport, LA INTRODUCTION Pseudothrombotic microangiopathy is a rare presentation of B12 (cobalamin) deficiency. Patients appear ill with elevated reticulocyte count, lactate dehydrogenase (LDH), and total bilirubin with low haptoglobin, platelet count, and anemia - deceivingly suggestive of thrombotic thrombocytopenic purpura (TTP), a type of true and deadly microangiopathic hemolytic anemia. CASE: A 36-year-old female with hypothyroidism presented for anemia with a hemoglobin of 5.1 g/dL and symptoms of fatigue, shortness of breath, palpitations, sweats, chills, vomiting, 54 lb weight loss, easy bruising and tingling in her fingertips and toes for one month. Exam was unremarkable other than pallor. She was found to have an LDH >4,000, haptoglobin