The Curious Case of - LSUHS Foundation 1012 OTI Mar-Apr... · The Curious Case of: Fever, Rash &...
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For staff, students, and faculty of LSU Health Shreveport School of Medicine School of Graduate Studies School of Allied Health Professionals Vol. 15, No. 2 March - April 2015 Inside on the Honors James Barrow, MD, Assistant Professor of OB/GYN: Certified by American Board of Obesity Medicine (ABOM) as an ABOM Diplomate Daniel Flowers, DPT, Physical Therapy Instructor: Certified as an Orthopedic Clinical Specialist, American Physical Therapy Association Roger Kim, MD FACS , Edward & Freda Green Professor in Surgical Oncology: Named Membership Liaison, American Hepato-Pancreato- Biliary Association Felicia Jackson, QEP/ Faculty Development Administrative Assistant: Recipient of a $1,000 scholarship from the local chapter of Human Resources Professionals Anil Nanda, MD MPH, Neurosurgery Chair: Visiting Professor, Invited by Kuwait Ministry of Health Rosario Maria S. Riel- Romero, MD FAAP FAAN, Professor of Neurology and Pediatrics: Associate Editor, Journal of Pediatric Neurology, Volume 12, Issue 4 Christian Samuelson, MD, Anesthesiology Resident: Named a Foundation for Anesthesia Education and Research (FAER) Scholar & Awarded $1,000, American Society of Anesthesiologists Tze-Woei Tan, MD FACS, Assistant Professor of Surgery: Appointed to Membership Committee of the American College of Surgeons Your Fellows Association Wayne Zhang, MD FACS, Associate Professor of Surgery: Honorary Professor, Shijitan Hospital and Visiting Professor, Anzhen Hospital, Capital Medical University, Beijing, China International Outreach Anil Nanda, MD MPH: “Complications, Public Health and Faith in Neurosurgery,” “Skull Base Surgery: The Sacred and Profane,” and “Is the Art of Surgical Clipping of Cerebral Aneurysms Facing Extinction?” Ibn Fina Hospital, Kuwait City, Kuwait; “The Sophrosyne of Skull Base Meningiomas,” Skull Base Conference, Pondicherry, India RECOGNITIONS The Curious Case of: Fever, Rash & Joint Pain By Matthew C. Raley, MD & Joan Blondin, MD Department of Internal Medicine Neville R. Dossabhoy, MD FACP FASN, Professor of Medicine: “Metabolic Acidosis – Review and Update for the Internist,” Aga Khan University Medical College, Karachi, Pakistan Wayne Zhang, MD: Co-Chairman and Moderator, New Cardiovascular Horizons Conference; Presenter, “Future Devices for EVAR and TEVAR,” “Diagnosis and Endovascular Treatment of Chronic Mesenteric Ischemia” and “Total Endovascular Repair of Complex Aortic Aneurysm with Fenestrated Endografts,” China Endovascular Course, Beijing, China Presentations Francesca Armstrong, Medical Student; Runhua Shi, MD PhD, Associate Professor, Feist-Weiller Cancer Center; Wayne Zhang, MD, and Tze-Woei Tan, MD: “Patients Who Required Surgery for Blunt Abdominal Aortic Injury Have a Higher Risk of Mortality, Pneumonia, and Longer Hospital Length of Stay,” Louisiana Chapter-American College of Surgeons Meeting, New Orleans Paige Bundrick, MD, Otolaryngology Resident: “Cytokine Profile of Murine Bone Marrow Derived Stem Cells, Triologic Society Meeting , Coronado, CA Neville Dossabhoy, MD: Co-author, “Effect of Diuretics on Body Fluid Spaces in Hypertensive Patients as Measured by Bioimpedance,”American Society of Nephrology, Philadelphia, PA Alex Gomelsky, MD, Chair and Professor of Clinical Urology: Co-author, “Factors Associated with Failure of a Repeat Mid- Urethral Sling Procedure,” American Urogynecologic Society/International Urogynecologic Association Annual Scientific Meeting, Washington, DC, and South Central Section of the American Urological Association Meeting, Rancho Mirage, LA John Neiner, MD, Otolaryngology Resident: “Tongue Blade Bite Test Predicts Mandible Fractures,” Triologic Society Meeting Tze-Woei Tan, MD: “Endovascular Treatment of Complex Aortic Aneurysms,” and “The Role of Imaging in Procedure Management,” New Cardiovascular Horizons Conference, Shreveport Publications Alex Gomelsky, MD: Co-author, “Urethral Melanoma in an Elderly Woman,” International Urogynecology Journal;“Urinary Incontinence in Women: Non-Pharmacologic Approaches and Newer Pharmacotherapies,” Minerva Medica; Co-author, “Clinical Use of Botulinum Neurotoxin: Urogenital Disorders Including Overactive Bladder,” Clinical Application of Botulinum Neurotoxin; “The Impact of Neurologic Insult on the Lower Urinary Tract,” “Surgery for Stress Urinary Incontinence and Pelvic Organ Prolapse,” “Surgery for Bladder Outlet Obstruction in the Male,” “Surgery for Neuropathic Bladder Dysfunction,” “Tissue Engineering for Neurogenic Bladder,” and “Electrical Stimulation and Neuromodulation,” Bladder Dysfunction in the Adult: the Basis for Clinical Management; “Bladder Emptying: Complete Emptying,” Urodynamics: Rapid and Practical Interpretation WHAT HAPPENED NEXT The patient had been seen multiple times by several physicians and still did not have an answer for why she was feeling so terrible. The medical team had a strong suspicion that she had a rheumatological condition but were unable to pinpoint an exact cause. She was admitted to the hospital for testing. • The fever spontaneously resolved and she began to feel better, but the rash remained • A biopsy on the rash was inconclusive. • Liver function tests were within normal ranges. • Imaging studies showed no hilar adenopathy or masses, no erosions, joint space narrowing or subluxation. • Hemoglobin was in normal ranges, but white blood count was slightly above normal ranges and C-Reactive protein was measured at 13.9. • Tests were negative for ANA, RF, HIV and hepatitis. • A work-up for anemia showed the patient’s ferritin level was remarkably elevated at 20,965. THE KEY TO DIAGNOSIS Only a handful of conditions will cause ferritin to rise that high, and out of those only Still’s Disease will present with such a chronic course. A diagnosis of Adult Onset Still’s Disease (AOSD) was made using the Yamaguchi Criteria. • AOSD is indicated when a patient meets five criteria, with at least two major on the Yamaguchi Criteria. The patient met four major and one minor: fever, rash, arthritis, leukocytosis and negative RF and ANA. • Rheumatology was consulted and the patient started on 60mg of prednisone daily. • After all infectious processes were ruled out, the patient was discharged. DISCUSSION AOSD is a rare rheumatologic disorder with incidence of 1.5:1,000,000, usually affecting young adults 16 to 35. It is a diagnosis of exclusion and should be suspected in patients with appropriate symptoms and negative workup. In a follow-up clinic visit, fever and joint pain were resolved, the patient’s ferritin had trended down and symptoms were improved. The patient was started on an Interlukin-1 inhibitor. (If you have an unusual case you would like to have considered for future Curious Case columns, send a brief description to [email protected]) A 35 year old African American female presented to the Emergency Department with recurrent fevers, rash, and joint pain which has plagued her intermittently for the past year. Her symptoms included symmetric arthritis involving her knees, ankles, shoulders, and hands. Fever typically associated with pruritic rash, was observed. e patient had been seen recently at another hospital and the rheumatologic workup was negative. e patient appeared distressed. Her physical exam otherwise revealed a fine evanescent, salmon-colored rash predominantly on her thighs, torso and upper arms. Matthew Raley, MD Joan Blondin, MD
Transcript of The Curious Case of - LSUHS Foundation 1012 OTI Mar-Apr... · The Curious Case of: Fever, Rash &...
For staff, students, and faculty of LSU Health Shreveport
School of MedicineSchool of Graduate StudiesSchool of Allied Health Professionals
Vol. 15, No. 2 March - April 2015 Insideon the
Honors
James Ba r row, MD, Ass is tant Professor of OB/GYN: Certified by American Board of Obesity Medicine (ABOM) as an ABOM Diplomate
Daniel Flowers, DPT, Physical Therapy Instructor: Certified as an Orthopedic Clinical Specialist, American Physical Therapy Association
Roger Kim, MD FACS , Edward & Freda Green Professor in Surg ica l O n c o l o g y : N a m e d Member s h ip L i a i s o n , American Hepato-Pancreato-Biliary Association
Felicia Jackson, QEP/Facu l t y Deve lopmen t Administrative Assistant: Recipient of a $1,000 scholarship from the local chapter of Human Resources Professionals
Anil Nanda, MD MPH, Neurosurgery Chair: Visiting Professor, Invited by Kuwait Ministry of Health
Rosario Maria S. Riel-Romero, MD FAAP FAAN, Professor of Neurology and Pediatrics: Associate Editor, Journal of Pediatric Neurology, Volume 12, Issue 4
Christian Samuelson, MD, Anesthesiology Resident: Named a Foundation for Anesthesia Education and Research (FAER) Scholar & Awarded $1,000, American Society of Anesthesiologists
Tze-Woei Tan, MD FACS, Ass is tant Professor of Surgery: Appointed to Membership Committee of the American College of Surgeons Your Fellows Association
W a y n e Z h a n g , M D FACS, Associate Professor of Surgery: Honorary Professor, Shijitan Hospital and Visit ing Professor, Anzhen Hospital, Capital Medical University, Beijing, China
International Outreach
Anil Nanda, MD MPH: “Complications, Public Health and Faith in Neurosurgery,” “Skull Base Surgery: The Sacred and Profane,” and “Is the Art of Surgical Clipping of Cerebral Aneurysms Facing Extinction?” Ibn Fina Hospital, Kuwait City, Kuwait; “The Sophrosyne of Skull Base Meningiomas,” Skull Base Conference, Pondicherry, India
RECOGNITIONSThe Curious Case of:
Fever, Rash & Joint Pain
By Matthew C. Raley, MD & Joan Blondin, MDDepartment of Internal Medicine
Neville R. Dossabhoy, MD FACP FASN, Professor of Medicine: “Metabolic Acidosis – Review and Update for the Internist,” Aga Khan University Medical College, Karachi, Pakistan
Wayne Zhang, MD: Co-Chairman and Moderator, New Cardiovascular Horizons Conference; Presenter, “Future Devices for EVAR and TEVAR,” “Diagnosis and Endovascular Treatment of Chronic Mesenteric Ischemia” and “Total Endovascular Repair of Complex Aortic Aneurysm with Fenestrated Endografts,” China Endovascular Course, Beijing, China
PresentationsFrancesca Armstrong, Medical Student; Runhua Shi, MD PhD, Associate Professor, Feist-Weiller Cancer Center; Wayne Zhang, MD, and Tze-Woei Tan, MD: “Patients Who Required Surgery for Blunt Abdominal Aortic Injury Have a Higher Risk of Mortality, Pneumonia, and Longer Hospital Length of Stay,” Louisiana Chapter-American College of Surgeons Meeting, New Orleans
Paige Bundrick, MD, Otolaryngology Resident: “Cytokine Profile of Murine Bone Marrow Derived Stem Cells, Triologic Society Meeting , Coronado, CA
Neville Dossabhoy, MD: Co-author, “Effect of Diuretics on Body Fluid Spaces in Hypertensive Patients as Measured by Bioimpedance,”American Society of Nephrology, Philadelphia, PA
Alex Gomelsky, MD, Chair and Professor of Clinical Urology: Co-author, “Factors Associated with Failure of a Repeat Mid-Urethral Sling Procedure,” American Urogynecologic Society/International Urogynecologic Association Annual Scientific Meeting, Washington, DC, and South Central Section of the American Urological Association Meeting, Rancho Mirage, LA
John Neiner, MD, Otolaryngology Resident: “Tongue Blade Bite Test Predicts Mandible Fractures,” Triologic Society Meeting
Tze-Woei Tan, MD: “Endovascular Treatment of Complex Aortic Aneurysms,” and “The Role of Imaging in Procedure Management,” New Cardiovascular Horizons Conference, Shreveport
Publications Alex Gomelsky, MD: Co-author, “Urethral Melanoma in an Elderly Woman,” International Urogynecology Journal;“Urinary Incontinence in Women: Non-Pharmacologic Approaches and Newer Pharmacotherapies,” Minerva Medica; Co-author, “Clinical Use of Botulinum Neurotoxin: Urogenital Disorders Including Overactive Bladder,” Clinical Application of Botulinum Neurotoxin; “The Impact of Neurologic Insult on the Lower Urinary Tract,” “Surgery for Stress Urinary Incontinence and Pelvic Organ Prolapse,” “Surgery for Bladder Outlet Obstruction in the Male,” “Surgery for Neuropathic Bladder Dysfunction,” “Tissue Engineering for Neurogenic Bladder,” and “Electrical Stimulation and Neuromodulation,” Bladder Dysfunction in the Adult: the Basis for Clinical Management; “Bladder Emptying: Complete Emptying,” Urodynamics: Rapid and Practical Interpretation
WHAT HAPPENED NEXTThe patient had been seen multiple times by several physicians and still did not have an answer for why she was feeling so terrible. The medical team had a strong suspicion that she had a rheumatological condition but were unable to pinpoint an exact cause. She was admitted to the hospital for testing.
• Thefeverspontaneouslyresolvedandshebegantofeelbetter, but the rash remained• Abiopsyontherashwasinconclusive.• Liverfunctiontestswerewithinnormalranges.• Imagingstudiesshowednohilaradenopathyormasses,noerosions, joint space narrowing or subluxation. • Hemoglobinwasinnormalranges,butwhitebloodcountwasslightly above normal ranges and C-Reactive protein was measured at 13.9. • TestswerenegativeforANA,RF,HIVandhepatitis.• Awork-upforanemiashowedthepatient’sferritinlevelwasremarkably elevatedat20,965.
THE KEY TO DIAGNOSISOnly a handful of conditions will cause ferritin to rise thathigh,andoutof thoseonlyStill’sDisease will present with such a chronic course. AdiagnosisofAdultOnsetStill’sDisease(AOSD)was made using the Yamaguchi Criteria.
• AOSDisindicatedwhenapatientmeetsfive criteria,withatleasttwomajoronthe Yamaguchi Criteria. The patient met four majorandoneminor:fever,rash,arthritis, leukocytosisandnegativeRFandANA.• Rheumatologywasconsultedandthe patientstartedon60mgofprednisonedaily.• Afterallinfectiousprocesseswereruledout, the patient was discharged.
DISCUSSIONAOSDisararerheumatologicdisorderwithincidenceof1.5:1,000,000,usuallyaffectingyoungadults16to35.Itisadiagnosisofexclusionandshouldbesuspectedinpatientswithappropriatesymptomsandnegativeworkup.Inafollow-upclinicvisit,feverandjointpainwereresolved,thepatient’sferritinhadtrendeddownandsymptomswereimproved.ThepatientwasstartedonanInterlukin-1inhibitor.
(If you have an unusual case you would like to have considered for future Curious Case columns, send a brief description to [email protected])
A 35 year old African American female presented to the Emergency Department with recurrent fevers, rash, and joint pain which has plagued her intermittently for the past year. Her symptoms included symmetric arthritis involving her knees, ankles, shoulders, and hands. Fever typically associated with pruritic rash, was observed. The patient had been seen recently at another hospital and the rheumatologic workup was negative.
The patient appeared distressed. Her physical exam otherwise revealed a fine evanescent, salmon-colored rash predominantly on her thighs, torso and upper arms.
Matthew Raley, MD Joan Blondin, MD
Publications continued
Wahib Isac, MD, Assistant Professor of Clinical Urology: Co-author, “Robot-Assisted Laparoscopic Partial Nephrectomy in Patients with Previous Abdominal Surgery: Single Center Experience,” International Journal of Medical Robotics and Computer Assisted Surgery; “Third Prize: Perineal Robot-Assisted Laparoscopic Radical Prostatectomy: Feasibility Study in the Cadaver Model” and “Perineal Robot-Assisted Laparoscopic Radical Prostatectomy (P-RALP): Feasibility Study in the Cadaver Model,” Journal of Endourology
Kasey Jackson, Pharmacology, Toxicology & Neuroscience Graduate Student, Robert Dayton, Pharmacology, Toxicology & Neuroscience Manager, and Ronald Klein, PhD, Associate Professor of Pharmacology, Toxicology & Neuroscience: Co-authors, “Preservation of Forelimb Function by UPF1 Gene Therapy in a Rat Model of TDP-43-Induced Paralysis,” Gene Therapy; “Initial Gene Vector Dosing for Studying Symptomatology of Amyotrophic Lateral Sclerosis in Non-Human Primates,” Journal of Medical Primatology
Roger Kim, MD FACS, Edward & Freda Green Professor in Surgical Oncology, and Timothy Gilbert, EdD, Director of QEP/Faculty Development: Co-authors, “The Effect of Surgical Resident Learning Style Preferences on American Board of Surgery In-Training Exam Scores,” Journal of Surgical Education
Roger Kim, MD: “Outcomes of Hybrid Video Assisted Thoracoscopic Surgery for Pulmonary Metastasectomy,” Journal Surgery and Science
Brijesh Manubhai Patel, MD, Assistant Professor of Medicine; Liam Morris, MD, Cardiology Fellow; Nuri Akkus, MD, Assistant Professor of Medicine; Alireza Hamidian Jahromi, MD, Surgery Resident; and Vyas Rao, MD, Clinical Associate Professor of Surgery: “Limited Circumferential Dissection of the Ascending Aorta Mimicking an Acute Coronary Syndrome” Journal of Louisiana State Medical Society
Vyas Rao, MD; Navdeep Samra, MD, Assistant Professor of Surgery; David Ballard, Medical Student; and Alireza Hamidian Jahromi, MD: “Acquired Post-Traumatic Aortic Coarctation Presenting as New-Onset Congestive Heart Failure: Treatment with Endovascular Repair,” Annals of Vascular Surgery
Robin Steed, PhD LOTR, Associate Professor of Occupational Therapy: “A Client-Centered Model of Instructional Design for Psychoeducation Interventions in Occupational Therapy,” Occupational Therapy in Mental Health (Named by Routledge as one of the most read articles in 2014)
MeetingsNeville Dossabhoy, MD: Named to Strategic Planning Session, American Society of Nephrology; Nominated to represent the National Kidney Foundation (NKF) of Louisiana’s Medical Advisory Board at the national NKF Medical Advisory Board’s Primary Care Initiative Committee, Philadelphia, PA
Cherie-Ann Nathan, MD FACS, Chair of Otolaryngology/Head & Neck Surgery: Named Steering Committee Member, 2016 Multidisciplinary Head and Neck Cancer Symposium, organized by the American Head and Neck Society (AHNS), the American Society of Clinical Oncology (ASCO) and the American Society for Radiation Oncology (ASTRO); Panel Host, “Surgical Salvage Treatment of Recurrent Head and Neck Tumors: Surgical/Ethical Dilemma, Triologic Society Meeting
Richard Wigle, MD FACS FCCM, Associate Professor of Clinical Surgery, Department of Surgery: ATLS Instructor, Joint Base San Antonio
Wayne Zhang, MD: Faculty Speaker, “Concepts for Easier Treatment of Juxta, Para and Thoracoabdominal Aortic Aneurysm Repairs,” and Moderator, Asia Podium and Poster Presentations, VEITH Symposium, New York, NY
Poster Presentations Alex Gomelsky, MD: “Contemporary Compar i son Be tween Re t ropub i c Midurethral Sling (MUS) and Autologous Pubovaginal Sling (PVS) for Stress Urinary Incontinence (SUI) after the FDA Advisory Warning,” American College of Surgeons Clinical Congress, San Francisco, CA
Blake LeBlanc, MD, Otolaryngology Resident: “Acute Subdural Hematoma: A Potential Complication of Cochlear Implantation,” Triologic Society Meeting
Adam Master, MD, Otolaryngology Resident: “A Rare Case of Intraductal Papilloma Arising From the Sublingual Gland,” Triologic Society Meeting
Zhiyun Yang, MD, Associate Professor of Radiology; Guy Alexander, MD, Radiology Resident; and Meghna Chadha, MD, Associate Professor of Radiology: “Complementary Sestamibi Scintigraphy and Ultrasound for Primary Hyperparathyroidism,” The American College of Nuclear Medicine Annual Meeting, San Antonio, TX
Zhiyun Yang, MD; Simon Long, MD, Radiology Resident; Guy Alexander, MD; Linda Nall, MD, Professor and Vice Chairman of Radiology; Horacio D’Agostino, MD, Professor and Chairman of Radiology; and Meghna Chadha, MD: “Improved Detection of Enlarged Parathyroid Glands by Ultrasound: Correlations with Sestamibi Scintigraphy and Surgical Outcome,” American College of Radiology Annual Conference on Quality and Safety, Phoenix, AZ
Aboutfouryearsago,ChiefofAllergy&ImmunologySamiBahna,MD,firstbecameinvolvedwithstartinga two-year Allergy/Immunology specialty programin India. The initiative was by one of his formerfellows,Dr.JayeshKanuga,whoisnowpracticinginNewJersey.Dr.Bahnarecentlytraveledbacktothecountrytocheckonitsprogress.
Dr. Bahna was joined on this latest trip by a delegation ofpresidentsandpastpresidentsfromtheAmericanCollege of Allergy, Asthma& Immunology and theAmericanAssociationofAllergistsandImmunologistsofIndianOrigin.TheymetwiththeIndianCouncilforMedicalEducationPresidentwhoindicatedthatthe
program application for the Diploma through the UniversityofDelhiChestInstituteisnowinthefinalstageofapproval.TheyalsogavelecturesattheV.P.Chest Institute inDelhi, the King EdwardMemorialHospital Chest Department in Mumbai, and theannualConferenceoftheNationalCollegeofChestPhysiciansinAgra.
“It is a great privilege to help in initiating the first formal program for Allergy & Immunology specialization in the large Indian subcontinent,” concluded Dr. Bahna. “I was pleased to see it so close to accepting trainees.”
Dr. BahnaOversees Founding
of Allergy/Immunology Specialty in India
CALENDARCME
April10 Levy Neurosurgery Conference Medical School Auditorium
18 6th Annual John C. McDonald Surgical Society Alumni Meeting Ernest’s Restaurant
25 4th Annual Ultrasound in Anesthesiology & Pain Management Conference Medical School Room 4-326
May13-16 14th Annual Intensive Review of Internal Medicine Shreveport Convention Center
For more information, visit lsuhscshreveport.edu/cme
Dr. Bahna, second from left, and the rest of the American delegation met with the President of the Indian Council for Medical Education
Department of Otolaryngology/Head & Neck Surgery residents Dr. Blake LeBlanc, Dr. Adam Master and Dr. John Neiner placed third, only behind UCLA and NYU, in the National Triologic Resident Bowl held in San Diego in late January. Residents were asked to dress to represent their area of the country. The group also placed first for the spirit award with Dr. Paige Bundrick coordinating the costumes.
A COMMANDER PERFORMANCE ENT Residents Represent
Over 100 people gathered in the auditorium Saturday for Gray Matter: Neuro Update 2015. The continuing medical education event was jointly sponsored by the Departments of Neurosurgery & Neurology.
(L to R): Neurosurgery Chair Dr. Anil Nanda, Visiting Neurosurgeon Dr. Jean Regis, Visiting Neurologist Dr. Alejandro Rabinstein and Neurology Chair Dr. Alireza Minagar
NEURO UPDATEDraws a Crowd
The following residency programs have recently received “Continued Accreditation” following the Accreditation Council for Graduate Medical Education (ACGME) annual review:
NeurosurgeryOrthopaedic SurgeryOphthalmologyPathologyCytopathology
OtolaryngologyAllergy/ImmunologyAnesthesiaObstetrics and Gynecology
Family Medicine (Shreveport, Rural, Alexandria, Monroe)
Residency Programs APPROVED
