Moderated Poster Discussions - Case Reports

Monday, April 14, 2025
5:30 pm - 6:45 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.

VENTRICULAR SEPTAL DEFECT POST-MYOCARDIAL INFARCTION PRESENTING AS FAILURE TO THRIVE AND CARDIOGENIC SHOCK: A CASE REPORT HIGHLIGHTING THE CRITICAL ROLE OF EARLY RECOGNITION AND REFERRAL (Cardiology / Cardiovascular Disease)
David G. Gonzalez-Sanchez, MD, University of Missouri Kansas City
Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide [1]. Ventricular septal defects (VSD) are a rare but life-threatening complication of MI, typically presenting with dyspnea, orthopnea, heart failure, and a new left lower sternal border holosystolic murmur [2,3]. We present a case that highlights an atypical presentation of post-MI VSD as multiple visits to the emergency department for failure to thrive, progressing to cardiogenic shock.
 

CORONARY ARTERY ECTASIA AND GIANT CORONARY ANEURYSMS AMIDST  SEVERE MITRAL VALVE REGURGITATION (Cardiology / Cardiovascular Disease)
Geoffroy A. Napon, MD, University of Iowa-Des Moines Internal Medicine
Giant coronary artery aneurysms (GCAAs), defined as aneurysms exceeding 2 cm in diameter, are exceptionally rare, with an estimated incidence of only 0.02%.1,2 These conditions can pose challenges for interventional procedures traditionally used to manage severe symptomatic mitral valve regurgitation. This case report presents the intricate management of an elderly patient with severe symptomatic mitral valve regurgitation, complicated by the presence of both GCAAs and coronary artery ectasia.
 

THE CRUCIAL ROLE OF PHYSICAL EXAMINATION IN UNCOVERING HIDDEN DIAGNOSIS (Cardiology / Cardiovascular Disease)
Abdul Wali Khan, University of Missouri Kansas City
In a healthcare landscape increasingly dominated by advanced imaging techniques and laboratory tests, the fundamental skills of physical examination often risk being undervalued. We present a case of a ventricular septal defect (VSD) that was accurately diagnosed through a detailed physical examination. This case highlights the critical role of a comprehensive history and thorough clinical examination in minimizing diagnostic errors and ensuring timely diagnosis and optimal patient care.
 

STRUGGLES OF MANAGING ESOPHAGEAL NECROSIS: A CLINICAL PERSPECTIVE (Cardiology / Cardiovascular Disease)
Abdul Wali Khan, University of Missouri Kansas City
Acute esophageal necrosis (AEN), also referred to as “black esophagus” or Gurvits syndrome, is a rare life-threatening condition characterized by necrosis of the esophageal mucosa on EGD, preferentially affecting the distal esophagus but can also affect the proximal and middle third. A higher risk of AEN is associated with comorbidities like diabetes, alcoholism, malnutrition, hypertension, kidney disease, and cardiovascular issues. We present a rarely reported case of AEN associated with elevated troponin levels, with limited management guidelines available, highlighting the importance of less aggressive approaches with an emphasis on careful patient selection.
 

AN ATYPICAL PRESENTATION OF DISSEMINATED VZV IN AN IMMUNOCOMPROMISED PATIENT (Dermatology)
Richard Moraga, BS, Rosalind Franklin University of Medicine & Science
Varicella zoster virus (VZV) is a common dermatologic condition, typically presenting in childhood as an exanthema with pruritic, painful skin lesions that progress from macules to vesicles and crusts. In older individuals with a history of chickenpox, reactivation of VZV leads to herpes zoster (shingles), presenting as unilateral, burning, vesicular eruptions along a dermatomal distribution. The most challenging form is disseminated herpes zoster, where lesions extend beyond the primary dermatomes and may affect the skin, eyes, and internal organs. This is suspected when at least 20 scattered vesicular lesions are observed. Atypical presentations, such as painless lesions, purple nodules, or hemorrhagic bullae, are common in immunosuppressed individuals and may delay diagnosis. This report presents a clinical case of atypical VZV.
 

PIGMENTARY DEMARCATION LINES: THREE CASES ENCAPSULATING A BENIGN CONDITION (Dermatology)
Natalia Chalupczak, BS, Chicago Medical School
Keloids are benign fibroproliferative growths characterized by the excessive deposition of collagen, extending beyond the boundaries of the original wound. They are the result of aberrant wound healing processes that lead to disorganized collagen synthesis and persistent inflammation. (1) While keloids can occur in any individual, there is a disproportionately higher prevalence among individuals with skin of color, particularly those of African, Hispanic, and Asian descent. (2) African Americans are notably more affected, with some studies estimating that dark-skinned individuals form keloids 15 times more frequently than do their lighter-skinned counterparts. (3) This disparity highlights the importance of exploring genetic, environmental, and hormonal contributions to keloid formation.

The pathogenesis of keloids remains incompletely understood but involves a complex interplay of molecular and cellular mechanisms. Transforming Growth Factor-β (TGF-β) plays a critical role by promoting fibroblast proliferation and upregulating collagen synthesis. (4) Additionally, overexpression of pro-inflammatory cytokines, dysregulation of apoptosis, and abnormalities in extracellular matrix remodeling are implicated. (5) Genetic predispositions, including polymorphisms in genes related to collagen synthesis and immune response, have also been identified. (6)

Keloids most commonly develop in areas subjected to high tension, such as the chest, shoulders, and earlobes. (7) However, cases involving widespread keloid formation affecting over 90% of the body surface area, as observed in this patient, are exceptionally rare and pose significant challenges for diagnosis and management.
 

DYSGENESIS OF THE CORPUS CALLOSUM AND PORENCEPHALIC CYST MIMICKING HOLOPROSENCEPHALY: IMPLICATIONS FOR ACCURATE PRENATAL DIAGNOSIS (Diagnosis or Treatment of a Disease Process or Clinical Syndromes)
Brian J. Kan, BSA, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine
Dysgenesis of the corpus callosum (DCC) and porencephalic cyst (PC) are rare fetal brain anomalies that can mimic more severe conditions like holoprosencephaly (HPE) on prenatal imaging. HPE, a developmental disorder of the forebrain, is often associated with significant neurological impairment or fatality, while DCC and PC may have a more favorable prognosis. This case underscores the challenges in distinguishing these conditions in-utero, emphasizing evolving prenatal diagnostics and coordinated care to optimize outcomes for mother and baby.
 

UNUSUAL PRESENTATION OF PERNICIOUS ANEMIA: HEMOLYSIS (Diagnosis or Treatment of a Disease Process or Clinical Syndromes)
Jacqueline Dragon, MD, Englewood Hospital and Medical Center
Vitamin B12/Cobalamin deficiency classically presents with neuropsychiatric symptoms from dietary insufficiency, nitrous oxide, or malabsorption. A high clinical suspicion is needed for rare presentations that mimic emergencies.
 

INTERPLAY BETWEEN UTERINE FIBROIDS AND DEEP VEIN THROMBOSIS: A CASE REPORT (Diagnosis or Treatment of a Disease Process or Clinical Syndromes)
Ayesha khan, MD, Insight Hospital and Medical Center
Deep vein thrombosis (DVT) can arise from various factors, including immobility, genetic predispositions, and hormonal influences. Mechanical obstructions, such as tumors or large fibroids, can impede blood flow and contribute to DVT formation. These obstructions are often overlooked, as symptoms may mimic other conditions, delaying accurate diagnosis and treatment.
 

ALLERGIC BRONCHOPLUMONARY ASPERGILLOSIS (ABPA) SANS ASTHMA: UNMASKING AN UNCOMMON CLINICAL ENTITY (Diagnosis or Treatment of a Disease Process or Clinical Syndromes)
Farwah Shah, MD, MPH, Insight Hospital and Medical Center
Allergic Bronchopulmonary aspergillosis is an immunologic pulmonary disorder resulting from hypersensitivity to Aspergillus Fumigatus most often found in patients with asthma or cystic fibrosis (1). This can result in permanent lung damage. This case report highlights the importance of early diagnosis and prompt management to prevent complications and disease progression.
 

PROGRESSIVE ABNORMAL NEUROLOGICAL DECLINE IN A PATIENT WITH MULTIPLE SPINAL DURAL ARTERIOVENOUS FISTULAS (Diagnosis or Treatment of a Disease Process or Clinical Syndromes)
Troy Suwondo, MPH, University of Nebraska Medical Center
A 75-year-old male with a history of recurrent spinal dural arteriovenous fistulas (SDAVFs), hydrocephalus, and eosinophilic granulomatosis with polyangiitis (EPGA).
 

CO-OCCURRENCE OF TWO PRIMARY HEAD AND NECK MALIGNANCIES: BASE OF TONGUE AND NASOPHARYNGEAL CARCINOMA (Hematology and Oncology / Bone Marrow Transplant)
Sione Markarian, BA, David Geffen School of Medicine, UCLA
Head and neck squamous cell carcinomas (HNSCC) represent a diverse group of malignancies originating from the mucosal surfaces of the oral cavity, pharynx, and larynx. The co-occurrence of two primary head and neck malignancies is an exceedingly rare clinical presentation. Nasopharyngeal carcinoma has an incidence of 25/100,000 in Asians versus 0.5/100,000 in the west. This case highlights a Caucasian male in his 7th decade with a 30-pack year smoking history who presented growing right sided neck mass. Biopsy confirmed synchronous poorly differentiated p16 positive HNSCC of the right base of tongue (BOT) but p16 negative left nasopharyngeal carcinoma. The p16 disparity confirmed the dual primary nature of his cancers. This distinction was crucial for proper chemoradiotherapy-based definitive intervention. Limited literature exists on the management of such cases, making an addition of a case like this to the medical literature, valuable for future clinicians.
 

MIND THE SMALL PRINT: A RARE VARIANT BCR::ABL1 BREAKPOINTS (E14A3) IN CHRONIC MYELOID LEUKEMIA (Hematology and Oncology / Bone Marrow Transplant)
Yuanli Lei, MD, University of Oklahoma Health Sciences Center
Translocation t(9;22)(q34;q11.2) and its variants that result in a BCR::ABL1 fusion gene is the main driver for chronic myeloid leukemia (CML) pathogenesis. Most CML cases (>95%) see breakage of the BCR gene downstream of exon 13 or 14 (e14) of BCR and upstream of exon 2 of ABL1. Less frequently, alternative transcripts with different breakpoints have also been reported. Such breakpoints/transcripts were categorized as major, minor, micro, and atypical based on their frequencies. BCR::ABL1 detection by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) is the standard practice for monitoring response to treatment and residual disease in the tyrosine kinase inhibitor era.
 

HEMOPHAGOCYTOSIS IN CEREBROSPINAL FLUIDS DURING IMMUNE EFFECTOR CELL-ASSOCIATED NEUROTOXICITY SYNDROME ASSOCIATED WITH CAR T-CELL THERAPY AXICABTAGENE CILOLEUCEL (Hematology and Oncology / Bone Marrow Transplant)
Yuanli Lei, MD, University of Oklahoma Health Sciences Center
Immune effector cell-associated neurotoxicity syndrome (ICANS) is a neuropsychiatric syndrome associated with chimeric antigen receptor (CAR) T-cell therapies. ICANS or neurotoxicity occurs in 74% of patients receiving axicabtagene ciloleucel. The median time of onset is 5 days (ZUMA-7 trial).[1] The incidence of hemophagocytic lymphohistiocytosis (HLH) in ZUMA-7/ZUMA-1 trials was 0% and 1% respectively. Although not fully understood, the combination of influx of circulating cytokines due to increased blood-brain barrier permeability and local production of cytokines by cells within the central nervous system (CNS), is believed to cause cortical and subcortical dysfunction in ICANS.[2]
 

SUBACUTE CEREBROVASCULAR ACCIDENT AND POSSIBLE SEIZURES TRIGGERED BY ELECTRONIC CIGARETTES (Hematology and Oncology / Bone Marrow Transplant)
Olaniyi Fadeyi, West Anaheim Medical Center
Adverse consequences of e-cigarettes have been a subject of debate since it was introduced to the market. Although, the most common adverse effect documented is respiratory cough [1], other worrisome side effects have been reported. Some of these health concerns which include e-cigarette or vaping use-associated lung injury (EVALI), stroke, seizures, cardiovascular diseases, bronchiolitis, and lipoid pneumonia have been seen. In fact, several seizure occurrence and other neurologic symptoms associated with the use of e-cigarettes were spontaneously reported between December 2010 and January 2019 according to the US food and drug association’s (FDA’s) center for tobacco products [2]. While it has been difficult to establish a causal relationship between the use of e-cigarettes and seizures, adulterated nicotine liquids have been suggested as being responsible for these episodes of e-cigarette-associated seizures.  Further, use of e-cigarettes by patients who are currently exposed to other triggers for hypercoagulability may accelerate thromboembolism and subsequently result into cerebrovascular accident (CVA) in patients with heart defects. Here, we report a case of a 22-year-old female who was brought to the hospital with complaints of seizures after using e-cigarettes. Further work-up revealed bilateral pulmonary emboli and subacute CVA.
 

WHEN TO STOP – PERSISTENT SYMPTOMS DESPITE TREATMENT (Infectious Disease / Immunization)
Salvador Fernandez, MD, Southern Illinois University School of Medicine
Infections of the central nervous system, particularly those that lead to distinct masses on imaging, can often be the cause of neurologic symptoms. Treatment of these infections frequently helps resolve these symptoms.  Certain complex infections, such as those with Mycobacterium tuberculosis, require longer courses of treatment. When this is coupled by persistent symptoms, it becomes difficult to determine when to finalize a course of treatment. We present a case of disseminated tuberculosis with intracerebral tuberculomas, with persistent symptoms despite appropriate therapy.
 

UNVEILING A RARE PATHOGEN CAUSING ACUTE NON-HEMATOGENOUS OSTEOMYELITIS OF THE FOOT (Infectious Disease / Immunization)
Mizba Baksh, MD, Insight Hospital and Medical Center Chicago
Osteomyelitis (OM), especially the non-hematogenous type, can spread from adjacent soft tissue wounds, and direct bone infection due to trauma, bites, or surgery.[1-3] It is usually caused by Staphylococcus aureus (including MRSA) and aerobic gram-negative bacilli, whereas less common agents include corynebacterium, fungi, and mycobacteria.[4-5] Data on rare causes such as Trueperella bernardiae (T. bernardiae) are limited. T. bernardiae, originally classified as a Corynebacterium species, is part of normal skin flora that can cause bacteremia, wound infections, and rarely post-surgical infections. Herein, we report the first case of acute non-hematogenous OM with T. bernardiae identified in tissue culture and biopsy.
 

SEVERE SEPSIS DUE TO BORDETELLA PETRII: A NOVEL PATHOGEN IN BACTEREMIA WITH IMPLICATIONS FOR IMMUNOSUPPRESSED PATIENTS (Infectious Disease / Immunization)
Lanah Almatroud, Michigan State University College of Human Medicine
Bordetella petrii (B. petrii) is a gram-negative bacillus (GNB) first isolated in 2001 from an anaerobic bioreactor enriched with river sediment (1). B. petrii is distinguished within the genus Bordetella by its large genome and extensive repertoire of virulence factors, which contribute to its notable antibiotic resistance (2). While localized infections caused by B. petrii have been reported, instances of bacteremia and sepsis due to this organism are not found in the literature. We present a case of B. petrii bacteremia in a patient with a history of pulmonary fibrosis, who developed severe sepsis following immunosuppressive treatment. To our knowledge, this is the first documented case of B. petrii as a causative agent of bacteremia leading to severe sepsis and ultimately death.
 

PELVIC INFLAMMATORY DISEASE CAUSED BY PASTEURELLA MULTOCIDA (Infectious Disease / Immunization)
Lea Kobrossy, North Dakota State University
Pelvic inflammatory disease (PID) refers to inflammation of the upper female genital tract, including the uterus, fallopian tubes, and ovaries. PID is most commonly caused by ascending sexually transmitted infections. However, non-sexually transmitted pathogens, such as Pasteurella multocida (P. multocida), can rarely lead to PID.  P. multocida is a fastidious gram-negative coccobacillus frequently found in oral flora of cats and dogs. It is a rare cause of infections in human, most commonly present as soft tissue infections, exposure can be a risk factor even without bites or scratches.  Previous reports have demonstrated that Pasteurella can cause systemic infections, including bacteremia, and in rarely, tubo-ovarian or pelvic inflammatory disease.
 

We report a case of 32-year-old woman with adenomyosis and psoriatic arthritis on methotrexate and adalimumab. She presented with persistent fevers and mild left side abdominal pain. Initial imaging was suggestive of left side pelvic inflammatory disease. Due to lack of improvement with medical treatment, patient underwent surgical intervention for source control,  a cell-free DNA assay identified P. multocida, which  didn’t grow in regular blood and tissue cultures.
 

MATERNAL-FETAL MEDICINE CONSIDERATIONS IN A PATIENT WITH CLIPPERS: A RARE NEUROLOGICAL DISORDER IN THE OBSTETRIC SETTING (Neurology)
Daniel Lovasz, BS, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a rare inflammatory demyelinating disorder of the central nervous system, with fewer than 100 cases reported in the literature. It is often misdiagnosed as other demyelinating or inflammatory disorders. CLIPPERS is characterized by pontine lesions and symptoms such as dizziness, diplopia, and headaches. This case highlights a pregnant patient with CLIPPERS from a Maternal-Fetal Medicine (MFM) perspective and the ongoing maintenance of remission during pregnancy without the use of maintenance therapy.
 

A PEDIATRIC CASE OF AN UNLIKELY SUBTYPE OF AUTOIMMUNE ENCEPHALITIS (Neurology)
Makaela Hamilton, DO, University of Illinois Chicago
Encephalitis is thought to be the result of inflammation of the brain parenchyma with consequent neuropsychiatric changes.1,2 Encephalitis is rare in pediatrics, the etiology being unexplained up to 50% of the time.3 More infrequent is Autoimmune encephalitis (AE), which alludes to self-directed immune mediated activities against neurologic tissue. Inflammation can be a key feature, with alterations to synapses and other non-inflammatory pathways driving neuropsychiatric changes. Progress in the field of molecular immunology has resulted in the recognition that many of the unexplained “idiopathic cases” are the result of autoimmunity, with antibody mediated processes now coming to the forefront. The most common antibodies associated with AE are anti-NMDAR, anti-MOG, and anti-GAD65. We hereby report a case of AE being the result of a rare antibody, P/Q-Type Calcium Channel antibody; due to its uncommon nature its neuropsychiatric phenotype has not been well described.
 

UNVEILING THE UNCOMMON: EPSTEIN BARR VIRUS-ASSOCIATED TRANSVERSE MYELITIS IN AN IMMUNOCOMPETENT HOST (Neurology)
Israr Khan, MD, Insight Hospital and Medical Center
Approximately 80-90% of adults in the United States are seropositive for the Epstein-Barr Virus (EBV). Infectious mononucleosis develops in 25-70% of cases; however, neurologic complications occur in 3% of cases, including aseptic meningitis, encephalitis, transverse myelitis (TM), autonomic neuropathy, and mononeuritis.(1,2) Acute TM is characterized by acute spinal cord dysfunction involving motor, sensory, and bowel or bladder abnormalities.(3) Most commonly occurs as an autoimmune process to post-infection or due to direct infection or other systemic autoimmune and demyelinating disorders.(4) TM is a rare complication of EBV.
 

A DIAGNOSTIC CHALLENGE: DIFFUSE ASTROGLIOSIS WITH LYMPHOCYTIC INFILTRATE (Neurology)
Alyaa Saleh, Central Michigan College of Medicine
The presentation of dizziness, nausea, and unsteady gait encompasses common symptoms with a broad differential diagnosis stemming from multiple potential etiologies, including vestibular, neurological, cardiovascular, and medication-related causes[1]. In the elderly, these symptoms may arise from age-related physiological changes, such as declining vestibular function, chronic comorbid conditions, and potential side effects from polypharmacy[2]. These symptoms frequently overlap, posing diagnostic challenges requiring careful assessment to pinpoint the underlying cause. We present a case report of an elderly patient with an anatomic cardiac anomaly who exhibited unresolved nausea, ataxia, and dizziness, with ambiguous initial neurological imaging.
 

EARLY ONSET OF CEREBRAL VENOUS THROMBOSIS IN PREGNANCY (Neurology)
EDY QUIZHPE, Universidad San Francisco de Quito
Cerebral venous thrombosis (CVT) in pregnancy is a very rare condition, but should not be confused with the clinical presentation of other common conditions such as pre-eclampsia. Although rare and difficult to diagnose, it is potentially serious and can increase maternal mortality. Diagnosis by imaging tests such as MRI and early treatment with heparin reduces maternal and perinatal mortality. Many predisposing factors can contribute to the development of CVT, including a history of thrombosis and thrombophilic disorders. However, the most individual risk factor is pregnancy or puerperium. This rare and uncommon pathology, has a prevalence ranging from 0.49 to 1.72 per 1000 deliveries depending on the country, 80% of which occur in the venous system and account for 10% of all maternal deaths. (1). Pregnancy is a hypercoagulable state prepared to prevent bleeding during childbirth or a miscarriage; nevertheless, it natural condition increase the risk to thrombotic four or five times that these events appear even is higher during the puerperium. (2, 3) The most common clinical manifestations are severe headache, seizures, nausea, vomiting and focal neurological deficit. (4, 5). Diagnosis based on neuroimaging and early treatment with anticoagulation are important to improve prognosis.
 

A PREGNANT WOMAN WITH RH VARIANTS AND MULTIPLE RH ALLOANTIBODIES (Pathophysiology / Pathology)
Heidi Christian, MD, University of Illinois Hospital and Health Sciences System
Rh variants may not be identified by typing prior to sensitization.  These antigenic variants differ in prevalence among ethnic groups and by clinical significance.  This is important to be aware of particularly when there is a discrepancy in donor and recipient populations.

AlloAbs may be more likely to form in the recipient population when there is a drastic difference in Ag expression from the donors.  Donor units may be challenging to locate in the case of alloAb formation to common RBC Ags.
 

MASSAGE GUN INDUCED SUBMASSIVE PULMONARY EMBOLISM (Pulmonary / Critical Care)
Nikhil Furtado, BS, Creighton University School of Medicine
The use of massage guns has increased significantly, with many individuals using them for muscle recovery, pain relief, and therapeutic purposes. However, while these devices have become a common tool for physical therapy, there is limited scientific evidence supporting their clinical effectiveness. Several case reports have highlighted serious complications associated with their use, including rhabdomyolysis, vertebral artery dissection, and pseudoaneurysms. This case report describes an extremely rare and severe complication of massage gun use—pulmonary embolism (PE)—illustrating the risks that may accompany these devices.
 

CHITOTRIOSIDASE: A MARKER OF THERAPEUTIC RESPONSE IN AFRICAN AMERICANS WITH SARCOIDOSIS (Pulmonary / Critical Care)
Tishena Lloyd, MD, University of Illinois at Chicago
Sarcoidosis is a heterogeneous systemic granulomatous disease of unknown etiology that primarily involves the lungs, and in the United States disproportionately affects African Americans. The decision to initiate immunosuppressive treatment is often made to prevent disease progression and irreversible fibrosis of involved organs. However, immunosuppression poses multiple risks and currently, there are no accurate biomarkers to help determine patient response to treatment or to guide treatment discontinuation.

Chitotriosidase, a chitinolytic enzyme that is predominantly secreted by activated macrophages, plays a role in the innate immune response. In the context of sarcoidosis, some cohorts have reported elevated chitotriosidase levels in over 90% of patients with active sarcoidosis and it has been proposed as a biomarker of disease activity that reflects macrophage activation and granuloma burden. Moreover, elevated chitotriosidase levels may indicate extrapulmonary involvement and increased severity of lung fibrosis. Conversely, in a European cohort, decreasing chitotriosidase levels were proposed to reflect therapeutic responses to effective immunosuppressive treatment. Despite this, there is a paucity of data on chitotriosidase level monitoring in African Americans, particularly in assessing disease activity and therapeutic response. 

Thus, in this case series, we explore the association between chitotriosidase levels and treatment in African American patients with diagnosis of sarcoidosis.
 

NOVEL USE OF MURPHY EYE FOR LEFT BRONCHIAL STENT PLACEMENT (Pulmonary / Critical Care)
Kendal Benson, Midwestern University Chicago College of Osteopathic Medicine
Lung cancer is one of the most common cancers diagnosed today and is the leading cause of cancer death in the United States. Of these patients 20-30% develop complications related to central airway obstruction, and 40% of deaths related to lung cancer are due to complications from regional growth (6). Malignant central airway obstruction can happen in three ways: malignant growth within the airway, extrinsic airway compression, and bronchial wall invasion with luminal occlusion. Debulking procedures, though not life-prolonging, aid the patient in breathing and oxygenation, which can enhance comfort in their final months (5). In certain cases, a stent may also be placed to increase airway patency (5). This procedure is done via bronchoscopy, most commonly through the primary distal opening of the endotracheal (ET) tube. The ET tube was first developed in the 1900s with the Murphy eye added in the 1950s, largely as a fail-safe to maintain the airway should the primary opening become occluded (1). We present a case demonstrating the potential therapeutic use of the Murphy eye, in place of the primary opening, when accessing the left bronchial tree.
 

SYSTEMIC SCLEROSIS PRESENTING AS OSTEOMYELITIS OF THE FINGER: PHYSICIANS MUST MAINTAIN A HIGH INDEX OF SUSPICION FOR SYSTEMIC SCLEROSIS WHEN EVALUATING PATIENTS WITH FINGERTIP ULCERATION OR INFECTION (Rheumatology)
Logan Van Poucke, BS, University of Illinois
Osteomyelitis, a challenging infectious disease predominantly caused by Staphylococcus aureus, involves bone infection via hematogenous spread, trauma, or contiguous tissue infection. Acute forms manifest with severe pain, fever, and systemic symptoms, while chronic cases present persistently with complications like necrotic bone tissue. Diagnosis combines imaging and microbiological culture, with treatment requiring prolonged antibiotics and often surgical intervention.

Raynaud's syndrome, characterized by episodic vasospasm in extremities, leads to triphasic color changes (pallor, cyanosis, rubor) triggered by cold or stress. It is classified as primary or secondary, often linked to systemic diseases like scleroderma. Diagnosis relies on clinical history and capillaroscopy, with management including trigger avoidance and pharmacological therapy.

Scleroderma, an autoimmune disease, involves vascular abnormalities and progressive fibrosis of skin and organs. Divided into limited and diffuse forms, it presents with skin tightening, Raynaud’s phenomenon, and systemic involvement. Diagnosis uses clinical criteria and serological markers, while therapy focuses on symptom management with immunosuppressants and biological agents.

These conditions share interconnections through systemic inflammatory and autoimmune processes. Scleroderma-associated vascular dysfunction predisposes to infections like osteomyelitis, exacerbated by Raynaud's-induced ischemia and digital ulcers. Immunosuppressive therapy further elevates infection risk. Understanding these shared mechanisms is crucial for integrated management of vascular, immune, and infectious aspects.
 

DUAL POSITIVITY FOR ANTI-MDA5 AND ANTI-PL-7 ANTIBODIES IN CLINICALLY AMYOPATHIC DERMATOMYOSITIS: A RARE PRESENTATION (Rheumatology)
Clare Omatsone, MD, University of Illinois, Chicago
Clinically amyopathic dermatomyositis (CADM) is a rare subset of idiopathic inflammatory myopathies characterized by skin manifestations without overt muscle involvement. Autoantibodies like anti-MDA5 are strongly associated with CADM and predict a high risk of rapidly progressive interstitial lung disease (RP-ILD). Conversely, anti-PL-7 is typically linked to anti-synthetase syndrome, characterized by myositis, ILD, mechanic’s hands, Raynaud’s phenomenon, and arthritis. As both antibodies are known to be associated with ILD, close monitoring for its development and prompt treatment are crucial. Dual positivity for anti-MDA5 and anti-PL-7 antibodies is exceedingly rare, with only a handful of cases reported worldwide. This unique case underscores the complexity of disease management, highlighting the interplay of distinct disease features and the need for individualized treatment strategies.
 

IATROGENIC HEPATITIS B LEADING TO POLYARTERITIS NODOSA: A COMPLICATION OF UNSCREENED BLOOD TRANSFUSION (Rheumatology)
Lanah Almatroud, Michigan State University College of Human Medicine
Polyarteritis nodosa (PAN) is a rare systemic necrotizing vasculitis that primarily affects medium-sized arteries, leading to significant morbidity due to organ ischemia and inflammation. While often associated with hepatitis B virus (HBV) infection, the incidence of HBV-related PAN has declined with widespread vaccination programs [1]. PAN linked to HBV is believed to result from immune complex deposition, triggering vascular inflammation and subsequent ischemic injury. Advancements in HBV vaccination and blood safety measures have significantly reduced the prevalence of HBV-related PAN. This report describes a case of HBV-related PAN in a patient who acquired HBV following unscreened blood transfusion in the 1980s, highlighting the complex interplay between chronic viral infections and systemic vasculitis.