Moderated Poster Discussions - Case Reports

Tuesday, April 15, 2025
2:10 pm - 3:20 pm

Case Report: An article that describes and interprets an individual case, often written as a detailed story. This may include unique cases that cannot be explained by known diseases or syndromes; cases that show an important variation of a disease or condition; cases that show unexpected events that may yield new or useful information; cases in which one patient has two or more unexpected diseases or disorders.

SEEING DOUBLE. SYMPTOMATIC BALANCE DOUBLE AORTIC ARCH IN NEWBORN, MULTIMODALITY IMAGINGS (Cardiology / Cardiovascular Disease)
Vithida Sueblinvong, MD, University of Illinois at Chicago
Balance double aortic arch is rare only 5-10% of all Double aortic arch. We reported a surgical repair in a 6 days old baby.

WOLFF-PARKINSON-WHITE SYNDROME UNMASKED BY REGADENOSON DURING MYOCARDIAL PERFUSION IMAGING (Cardiology / Cardiovascular Disease)
David G. Gonzalez Sanchez, MD, University of Missouri Kansas City
Myocardial perfusion imaging (MPI) aided by pharmacologic stress is a standard diagnostic modality for detecting myocardial ischemia. Regadenoson, a selective A2A adenosine receptor agonist, is commonly used due to its favorable side effect profile [1, 2]. While arrhythmias such as atrial fibrillation (AF) have been reported with regadenoson, there are no known reports in the literature or manufacturer data linking it to the induction of Wolff-Parkinson-White (WPW) syndrome. This case highlights a rare instance of WPW unmasked following regadenoson administration.

A RARE CASE OF POST-MI HEART FAILURE IN THE SETTING OF VENTRICULAR SEPTAL ANEURYSMS WITHOUT VSD, AORTIC INSUFFICIENCY, AND SUBAORTIC MEMBRANE: MANAGEMENT CONSIDERATIONS (Cardiology / Cardiovascular Disease)
David G.. Gonzalez-Sanchez, MD, University of Missouri Kansas City
Management of heart failure with reduced ejection fraction (HFrEF) must be tailored to the underlying cause of cardiac dysfunction. The most common causes of HFrEF are ischemic disease, hypertensive heart disease, congenital heart disease, and valvular disease (5). Multifactorial etiologies are not uncommon, and when encountered, the degree of dysfunction attributable to each cause must be assessed with a thorough diagnostic workup and evaluation of treatment response.

Here we present the management of a patient diagnosed with HFrEF following myocardial infarction (MI) in the context of complex structural heart disease, including aortic insufficiency (AI), subaortic membrane, and post-MI septal ventricular aneurysms without VSD.

A CLINICAL EXPLORATION OF ONE OF THE LONGEST DOCUMENTED SINUS PAUSES IN AN AMBULATORY PATIENT (Cardiology / Cardiovascular Disease)
Alyaa Saleh, Central Michigan College of Medicine
Cardiac conduction system abnormalities, such as sinus nodal dysfunction and AV block, can lead to significant bradyarrhythmias and pauses, potentially causing symptoms like dizziness and loss of consciousness. Monitoring these rhythm disturbances is crucial, as they may evolve and indicate underlying structural heart disease or lead to more serious arrhythmias, such as ventricular asystole.

AN UPDATED REVIEW OF DISSEMINATED HERPES ZOSTER AND PRACTICAL PEARLS (Dermatology)
Richard Moraga, BS, Rosalind Franklin University of Medicine & Science
Varicella zoster virus (VZV) often presents in childhood as pruritic skin lesions. Challenging cases include disseminated herpes zoster, which involves widespread lesions beyond primary dermatomes. Atypical presentations, like painless lesions and violaceous nodules, are common in immunosuppressed individuals, causing diagnostic delays and treatment errors due to its mimicry to other conditions. We present two clinical cases of disseminated herpes zoster.

A CASE OF NON-KERATINIZING SQUAMOUS CELL CARCINOMA (Diagnosis or Treatment of a Disease Process or Clinical Syndromes)
Nathan S. Brar, Dignity Health

Throat Cancer is a rare disease, with squamous cell carcinoma of the oropharynx being the most common form of oropharyngeal cancer. Squamous Cell Carcinoma is closely associated with Human Papillomavirus (HPV) infection, typically affecting men in their 60s. The case presented today is about a 73-year-old Caucasian Male who was admitted to the hospital due to experiencing a variety of symptoms regarding the ear and throat. The patient after this, the patient had an episode of small bowel obstruction, which warranted an NG tube placement, which then caused the patient to experience a sore throat. A few weeks later, the patient developed painful swallowing and right-sided neck swelling, resulting in a 2cm right peritonsillar/parapharyngeal abscess. ENT drained the abscess, and pathology revealed HPV-16 but no sign of malignancy. Unfortunately, the patient’s symptoms continued to worsen, leading to an excision of the lymph nodes to be taken and confirm that the patient has Non-Kerantinizing Squamous Cell Carcinoma of the Oropharynx.

UNRELENTING HEADACHE: A PUZZLING CASE IN A YOUNG FEMALE (Diagnosis or Treatment of a Disease Process or Clinical Syndromes)
Farwah Shah, MD, MPH, Insight Hospital and Medical Center
Headaches are a common clinical complaint, with migraines and tension-type headaches being the most frequently encountered primary types. Secondary headaches, which arise from underlying pathologies, can present diagnostic challenges. This case report focuses on a rare secondary headache associated with cerebellar tonsillar ectopia (CTE) due to idiopathic intracranial hypertension (IIH). Although CTE may mimic Chiari malformation, it is less frequently addressed in the literature. This case report emphasizes the importance of detailed imaging and thorough clinical evaluation to differentiate between IIH-related ectopia and Chiari I malformation, aiming to enhance awareness and management of this complex condition.

HOPE IS A CONVERSATION: THE ROLE OF EARLY PALLIATIVE CARE IN NAVIGATING NEUROPROGNOSTICATION CHALLENGES AFTER CARDIAC ARREST (Diagnosis or Treatment of a Disease Process or Clinical Syndromes)
Chadane Thompson, MD, Department of Medicine, Englewood Hospital and Medical Center
Neuroprognostication involves predicting the potential for neurological recovery from disorders of consciousness caused by brain injury. Following neuroprognostication that indicates poor outcomes after cardiac arrest, families and surrogate decision-makers of comatose survivors are often confronted with difficult decisions regarding withdrawal of life-sustaining treatment (WLST). A palliative care framework that recognizes the challenges of neuroprognostication and supports complex ethical and culturally sensitive decision-making may help curtail premature WLST in patients with falsely pessimistic prognoses.

EFFECTIVENESS OF OMT LYMPHATICS AND FUROSEMIDE IN RESOLUTION OF MASSIVE SEROMA (Diagnosis or Treatment of a Disease Process or Clinical Syndromes)
Shreya Tamatam, OMSIII, Western University of Health Scienes
Gluteal augmentation and lift, or a Brazilian Butt Lift (BBL), is an increasingly popular cosmetic procedure that patients pursue for a more lifted and defined shape to their buttocks. Post-op complications include localized swelling and seroma, which are routinely managed with compression garments (Dixit and Wagh, 2013).

RAPID WEIGHT GAIN AS INITIAL PRESENTATION OF GROWTH HORMONE DEFICIENCY IN A PEDIATRIC PATIENT (Endocrinology / Metabolism)
Troy Shirley, BS, University of Alabama at Birmingham Heersink School of Medicine
This report highlights a case of growth hormone deficiency (GHD) in a 9-year-old girl, where parental persistence and access to specialized care played pivotal roles in the patient’s diagnosis and treatment. The case underscores the importance of considering GHD as a differential diagnosis in pediatric patients presenting with both growth failure and rapid weight gain.

GALLBLADDER ADENOMYOMATOSIS PRESENTING WITH INTRACTABLE NAUSEA AND VOMITING (Gastroenterology / Clinical Nutrition)
Olaniyi Fadeyi, West Anaheim Medical Center
Gallbladder adenomyomatosis (GAM) is a benign disease of the gallbladder with an excellent prognosis in most patients. [1] It is characterized by gallbladder wall thickening with a typical inward folding of the epithelium thereby forming Rokitansky-Aschoff sinuses. [2] While it may be found at any age, peak incidence of GAM is in the sixth and seventh decade of life. [3] GAM is a common incidental finding on routine abdominal ultrasound performed for other unrelated health issues. [4] Asymptomatic patients are usually monitored without any need for intervention. However, symptomatic patients are treated with cholecystectomy. Although, presenting symptoms in symptomatic patients may be nonspecific, abdominal pain, nausea, vomiting, and fever are common. [5] Herein, we report a case of symptomatic GAM seen in a hospitalized patient whose predominant symptoms were nausea, vomiting and right upper quadrant abdominal pain.

A RARE PRESENTATION OF PAINLESS PANCREATITIS IN THE SETTING OF PANNICULITIS AND POLYARTHRITIS (Gastroenterology / Clinical Nutrition)
Amani Masoud, DO, Franciscan Health Olympia Fields
Pancreatitis-Panniculitis-Polyarthritis (PPP) syndrome is a rare presentation of acute pancreatitis comprising external manifestations of polyarthropathy and panniculitis1. It is often only identified when patients present with the triad of gastrointestinal symptoms, joint pain and cutaneous changes. In patients with arthritis and skin changes alone, the diagnosis of acute pancreatitis in PPP syndrome may be missed. Our case involves a patient with painless acute pancreatitis in the setting of panniculitis and polyarthritis. This highlights the importance of assessing for acute pancreatitis in patients with panniculitis and polyarthropathy, since prompt initiation of treatment reduces the morbidity and mortality of acute pancreatitis.

IRON DEFICIENCY ANEMIA SECONDARY TO NEGLECTED GIANT SKIN CANCERS; HIGHLIGHTING THE ROLE OF PSYCHOSOCIAL BARRIERS IN PATIENT OUTCOMES-A CASE SERIES (Health Disparities / Diversity / Equity / Inclusion / Social Determinants / Ethics)
Aren Dermarderosian, BS, University of California, Los Angeles
Skin cancer is the most common type of cancer worldwide, with approximately 3 million new cases annually. Basal cell carcinoma (BCC) is the most prevalent subtype, accounting for 80% of all cases, followed by squamous cell carcinoma (SCC). Basosquamous carcinoma (BSC), a rare and aggressive subtype, exhibits characteristics of both BCC and SCC. Tumors measuring >5 cm are classified as "giant" and often arise due to neglect of alarming skin growths, influenced by psychosocial factors (PF) and poor health literacy (HL). While discernible skin lesions are a primary sign of skin cancer, symptomatic anemia is an extremely rare presentation, with only a few cases documented in the literature. We present two cases of iron deficiency anemia (IDA) secondary to giant BSC and SCC, highlighting the role of psychosocial challenges in exacerbating these conditions and the importance of addressing these barriers to improve outcomes.

FROM TEQUILA TO THROMBOSIS: A YOUNG MALE’S UNLIKELY JOURNEY FROM ALCOHOLIC PANCREATITIS TO THROMBOTIC THROMBOCYTOPENIC  PURPURA (Hematology and Oncology / Bone Marrow Transplant)
Farwah Shah, MD, MPH, Insight Hospital and Medical Center
Thrombotic Thrombocytopenic Purpura (TTP) is a rare, life-threatening thrombotic microangiopathy characterized by the formation of blood clots in small vessels throughout the body. Its hallmark clinical features include fever, thrombocytopenia, neurological abnormalities, microangiopathic hemolytic anemia (MAHA), and renal failure. TTP can be either inherited, resulting from mutations in the ADAMTS13 gene inherited from both parents, or acquired, often triggered by autoimmune conditions, cancer, medications, HIV, infections, pregnancy, or stress [1]. Here, we present a rare case of acute pancreatitis-induced TTP, a condition that, while fatal if untreated, is treatable with urgent diagnosis and therapy [2,3].

A CASE REPORT OF RUXOLITINIB DISCONTINUATION SYNDROME LEADING TO RAPID MULTI-ORGAN FAILURE (Hematology and Oncology / Bone Marrow Transplant)
Danyal Butt, MD, University of Toledo Medical Center
Ruxolitinib (RTX) is a JAK1/JAK2 inhibitor approved for treating myelofibrosis (MF) and polycythemia vera (PV). Upon discontinuation, patients may experience Ruxolitinib Discontinuation Syndrome (RDS), often presenting with complications such as splenomegaly, cytopenia, acute kidney injury, and worsening of MF. Severe complications such as ARDS, tumor lysis syndrome, and septic-like shock can rarely occur. Although RDS is documented, rapid progression to multi-organ failure and death after RTX discontinuation is extremely rare. We report a fatal case of a 73-year-old male who developed multi-organ failure after abrupt RTX discontinuation, emphasizing the importance of vigilant management.

ABDOMINAL PAIN AND SEVERE BILATERAL HYDRONEPHROSIS CAUSED BY METASTATIC TESTICULAR SEMINOMA (Hematology and Oncology / Bone Marrow Transplant)
Olaniyi Fadeyi, West Anaheim Medical Center
Testicular cancer is a very common malignancy seen among males between 15-35 years old. [1] Certain risk factors which may include cryptorchidism, testicular trauma, family history of testicular cancers and germ cell tumor may be significant to the development of testicular malignancy. As previously documented, history of cryptorchidism is very significant to the development of testicular cancers. [2] Although testicular seminoma is chemosensitive, late presentation may constitute a significant challenge to treatment and prognosis. It is noteworthy that there are currently no generally acceptable guidelines to screen for testicular cancers. Testicular self-examination is only recommended by United States Preventive Services Task Force (USPSTF) in the context of history of cryptorchidism and germ cell tumor since it has not been generally proven to improve outcomes. [3] And regardless of the common presentation of testicular cancers as mass and swelling, several forms of atypical presentations in the context of metastatic testicular seminoma have been documented in previous studies. Here, we present a case of a 44-year-old male who was diagnosed with testicular seminoma causing abdominal pain and bilateral hydronephrosis.

AN UNUSUAL CASE OF METASTATIC CECAL ADENOCARCINOMA PRESENTING WITH WHIPPLE'S TRIAD (Hematology and Oncology / Bone Marrow Transplant)
Dileep Mandali, MD, Tulane University School of Medicine
Hypoglycemia in liver cancer arises from the liver's inability to meet the body's glucose demands, as the tumor extensively replaces normal liver parenchyma. Additionally, elevated production of insulin-like growth factor (IGF) contributes to this condition. It is commonly associated with both islet cell and non-islet cell tumors, with a higher prevalence in non-islet cell tumors due to paraneoplastic syndrome and the tumor's increased metabolic demands. Here, we present a case of non-islet cell tumor that confounded the findings typical of islet cell tumor on imaging (ie, Whipple's Triad), thereby highlighting the importance of thorough work-up for treatment and longterm management.

CTLA-4 HAPLOINSUFFICIENCY: REPORT OF SUSTAINED RESPONSE TO LONG TERM TREATMENT WITH ABATACEPT (Immunology / Allergy)
Nishant R. Tiwari, MD, OU Health Peggy and Charles Stephenson Cancer Center
Cytotoxic T-lymphocyte associated protein 4 (CTLA-4) haploinsufficiency (CHAI) is a rare immune dysregulation disorder with a spectrum of phenotypic presentations. Lymphopenia, autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), enteropathy, increased susceptibility to malignancies, hypogammaglobulinemia, and neurological issues are observed in patients with CHAI at varying frequencies and severities. [1] We report a case of CHAI in a young adult treated with abatacept, showing sustained response and good tolerability to the treatment.

ITCHING FOR AN ANSWER: THE FIRST KNOWN CASE OF EPIDERMOLYSIS BULLOSA ACQUISITA (EBA) IN THE SETTING OF ITCH DEFICIENCY (Immunology / Allergy)
William Prieto, BS, MS, WMU Homer Stryker M.D. School of Medicine
ITCH deficiency, a rare autosomal recessive disorder, manifests as a syndrome of short stature, developmental delay, hypotonia, syndromic facial features, and can include chronic lung disease, recurrent infections, and several autoimmune diseases, including hypothyroidism, hepatitis, enteropathy, and diabetes mellitus.  Only 12 cases have been reported to date, caused by mutations of ITCH (MIM 606409) on 20q11, leading to ITCH E3 ubiquitin ligase deficiency. E3 ubiquitin ligases regulate all protein metabolism by tagging proteins for degradation by proteasomes. Dysfunction in E3 ligases is thought to regulate immunity by allowing survival of autoreactive T-cells, leading to loss of self-tolerance and subsequent autoimmunity. Treatment of ITCH deficiency usually requires significant immunosuppression and infection control; one successful stem cell transplant has been reported.

CYCLICAL FEVER OF UNKNOWN ORIGIN IN AN 84-YEAR-OLD PATIENT: RESOLUTION WITH DOXYCYCLINE (Infectious Disease / Immunization)
Lea Kobrossy, North Dakota State University
Fever of unknown origin (FUO) is classically defined as fever exceeding 38.3 °C (101 °F) for more than three weeks without identified source despite basic diagnostic workup. In older and immunocompromised patients, atypical infections, malignancies, and non-infectious inflammatory conditions should be considered. Myelodysplastic syndrome (MDS) is a clonal disorder of hematopoietic stem cells characterized by ineffective hematopoiesis, leading to decrease production of normal blood cells. Although fevers in MDS could be attributed to common infections, the possibility of a paraneoplastic or atypical infectious etiologies should be investigated, specifically when standard diagnostic tests fail to identify an etiology. This report describes an 84-year-old woman who presented with a pattern of weekly recurring high fevers. Extensive testing excluded common pathogens, including tick-borne diseases, and she demonstrated clinical resolution after a therapeutic trial of doxycycline which was chosen for its intracellular activity against many zoonotic atypical infections which might present with cyclic fevers.

DISSEMINATED AND PULMONARY BLASTOMYCOSIS IN A PEDIATRIC PATIENT OF CENTRAL NEW YORK (Infectious Disease / Immunization)
Maxence Isabelle Marie Gilles, DO, SUNY Upstate
Blastomycosis is an infection caused by Blastomyces spp., a dimorphic fungus that lives primarily in soil and decaying plant matter. It is endemic in the midwestern, south-central, and southeastern United States. Cases have been reported outside of endemic regions. Half of infections are symptomatic, presenting as acute or chronic pneumonia and rarely progressing to acute respiratory distress syndrome (ARDS) and disseminated disease.

DRUGS ON THE BRAIN: TRIMETHOPRIM-SULFAMETHAZINE INDUCED ASEPTIC MENINGITIS FOLLOWING TRAUMATIC KNEE ARTHROTOMY (Infectious Disease / Immunization)
Kendall Johnson, Western Michigan University Homer Stryker M.D. School of Medicine
Trimethoprim-sulfamethoxazole (TMP-SMX) is a frequently prescribed antibiotic; however, it may be associated with a diverse range of adverse effects that could potentially be misinterpreted as the exacerbation of an underlying infectious process. Drug-induced aseptic meningitis (DIAM) presents a particularly challenging clinical scenario when treating systemic infections. Symptoms such as cephalalgia, cervical rigidity, and pyrexia may raise concerns regarding meningitis and the progression of the underlying infection. The pathophysiology of this delayed hypersensitivity reaction remains incompletely elucidated; nevertheless, direct meningeal irritation has been proposed as a potential mechanism of DIAM. We present the case of a previously healthy 11-year-old male treated for septic arthritis with TMP-SMX, who developed pyrexia, meningeal signs, and knee pain on the ninth day of therapy, attributable to his antibiotic regimen.

NEONATAL MENINGITIS DUE TO STREPTOCOCCUS PNEUMONIAE: AN UNCOMMON CLINICAL CHALLENGENEONATAL MENINGITIS DUE TO STREPTOCOCCUS PNEUMONIAE: AN UNCOMMON CLINICAL CHALLENGE (Infectious Disease / Immunization)
Alyaa Saleh, Central Michigan College of Medicine
Neonatal infections within the first 72 hours of life are often acquired perinatally as the infant traverses the birth canal. Group B streptococcus is the leading cause of early-onset neonatal sepsis, largely due to perinatal transmission from a colonized mother (1). Escherichia coli is another common perinatally acquired infection, especially in the presence of chorioamnionitis (2). Streptococcus pneumoniae (S. pneumoniae) infections in neonates are uncommon (1%–11% of neonatal sepsis), and when they occur, they are associated with substantial morbidity and mortality (3). In this case, we report early neonatal respiratory distress due to meningitis caused by S. pneumoniae.

FIREARM PROJECTILE PENETRATING HEAD TRAUMA (Neurology)
Jacqueline Rodríguez, MD, Emergency Medicine Service, Enrique Garces Hospital
Penetrating traumatic brain injury is a rare medical emergency, accounting for 0.4% of all cranial injuries, with a mortality rate of up to 90% (1,2). Over 90% of these injuries are caused by interpersonal violence, predominantly affecting males and the left side of the head, as most assailants are right-handed (3). Physiopathologically, the projectile causes damage through direct penetration and pressure waves that travel through brain tissue. These waves trigger an inflammatory process that can lead to irreversible damage or death. The temporal and orbital regions are particularly vulnerable to such injury (3).  Patients who survive to hospital admission require immediate evaluation with non-contrast cranial computed tomography (CT) and assessment with the Glasgow Coma Scale (GCS) to determine the need for surgical intervention (4,5).

CUTANEOUS LEUKOCYTOCLASTIC VASCULITIS AS THE HERALD OF SYSTEMIC LUPUS ERYTHEMATOSUS (Rheumatology)
Monique Fagan, MBBS, Department of Internal Medicine, Tulane University School of Medicine
Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease causing organ damage via immune complex deposition and tissue-specific antibodies(1). While common cutaneous manifestations include non-scarring alopecia, acute cutaneous lupus, and discoid lupus, leukocytoclastic vasculitis (LCV) is a less specific presentation(2). Small vessel vasculitis occurs in 11–20% of SLE cases, primarily as cutaneous lesions, though it rarely presents as the initial symptom without other features(3). This report highlights a case of recurrent cutaneous LCV in a 47 year-old female, leading to SLE diagnosis.

CROHN’S DISEASE IN REMISSION DISGUISED AS RECURRENT LEUKOCYTOCLASTIC VASCULITIS: A RARE CLINICAL PRESENTATION (Rheumatology)
Rayan Gasim, MD, Hackensack University Englewood Hospital IM program
Leukocytoclastic vasculitis (LCV), a small-vessel vasculitis typically presenting with a painful rash, is a rare but known extraintestinal manifestation of Crohn’s disease. LCV generally occurs during active disease but is seldom seen during periods of remission. The case described is unique in that a patient with long-standing Crohn's disease currently in remission presented with recurrent, self-limiting LCV despite no active gastrointestinal (GI) symptoms. This report highlights an atypical presentation and discusses both the diagnostic and management challenges.

SHADOW CAST BY STATIN: NAVIGATING MYOPATHY (Rheumatology)
Israr Khan, MD, Insight Hospital and Medical Center
Statins are widely prescribed lipid-lowering medications that provide significant benefits for preventing and treating cardiovascular diseases. Although considered safe, muscle-related side effects ranging from myalgia to rhabdomyolysis, particularly with high-dose statin usage, are well documented. Statin-associated autoimmune myopathy (SAAM) is rare; however, this devastating complication can occur at any time after statin initiation.(1,2)