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CASE REPORT
2018 Winners of the American College of Physicians – Delaware Chapter Medical Resident and Student Clinical Vignette Competition
The Annual Scientific Meeting of the American College of Physicians (ACP) – Delaware Chapter took place at Christiana Care in Newark, Delaware on Saturday February 10, 2018. Prizes were awarded to medical students and residents for top-rated abstracts and posters. The winners of the abstract competition were sponsored to present at the National ACP Student Poster Competition in New Orleans. Winners of the poster competition received cash awards.
Presented here are the top-rated abstracts by the winners of the Clinical Vignette category.
MEDICAL STUDENT AWARDS
ABSTRACT: FIRST PRIZE
Case of Legionella Endocarditis with Rapidly Progressive Glomerulonephritis
By Peter Block, MS4; Ugochukwu Amadi, MD; Timothy Roedder, DO and John Donnelly, MD
Introduction
Legionella-associated endocarditis is a rare phenomenon. To date, only 16 cases have been reported in the literature.1 In turn, there is a limited understanding of downstream complications from this infection. Here, we describe a case of legionella endocarditis complicated by rapidly progressive glomerulonephritis (RPGN).
Case Presentation
The patient was a 49-year-old man with a childhood history of
two aortic valve replacements, who was referred to our hospital
intermittent fevers, pleuritic chest pain, hemoptysis, and hematuria. A pulmonary-renal syndrome was initially suspected, though extensive workup was unremarkable for most autoimmune or infectious etiologies, including ANCA titers, SLE, RA, HIV, HBV, HCV, M. tuberculosis, Bartonella, C. burnetii, Streptococcus
spp., staphylococcus, or HACEK organisms. In contrast, urine antigen for legionella was positive on two separate tests. In light of worsening renal function, culture-negative endocarditis with renal complications became a leading diagnosis. The patient was therefore started on broad-spectrum antibiotics. Renal biopsy revealed RPGN and trans-esophageal echocardiogram showed a vegetation on the patient’s prosthetic aortic valve. Thus, a diagnosis of Legionella- associated endocarditis with complicating RPGN was made, as
subsequently placed on a six-week course of azithromycin and
hemodialysis, as well as an immunosuppressive regimen based upon the CYCLOPS Trial2 for treatment of RPGN. He was ultimately discharged in clinical stability, with completion of his infectious and renal treatment regimens as an outpatient, as well as follow-up with cardiothoracic surgery for potential valve replacement.
Discussion
This case describes both an unusual presentation and previously unreported complication of legionella endocarditis. Whereas
most prior reports occurred during the perioperative period of cardiothoracic surgery,1 the patient described here developed extra- pulmonary manifestations of Legionella decades after his last valve
of RPGN secondary to Legionella-associated endocarditis. Thus, this case highlights Legionella as a viable cause of culture-negative endocarditis, illustrating a novel downstream complication of its infection.
REFERENCES
1. Baumgartner V, et al. Legionella Native Valve Endocarditis Case Report
and Review of Literature. Archives of Internal Medicine. 2016. 9(14).
2. de Groot K, et al. Pulse Versus Daily Oral Cyclophosphamide for Induction of Remission in Antineutrophil Cytoplasmic Antibody- Associated Vasculitis: A Randomized Trial. Annals of Internal Medicine. 2009. 150(10):670-680.
STUDENT POSTER FIRST PRIZE
Osmotic Demyelinating Syndrome Caused by Normonatremic Hyperglycemia
By Anika Ross, MS4; Heather Ragozine-Bush, MD and James Ruether, MD
Introduction
Osmotic Demyelination Syndrome (ODS) is classically caused by rapid correction of hyponatremia, shifting the serum osmolality. Typical symptoms of ODS are dysarthria, dysphagia, ataxia, a
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