Page 28 - Delaware Medical Journal - May/June 2020
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MEDICAL STUDENT POSTER WINNERS
1st Prize, Poster: A Tale of Two Pathogens by Nicole Scaramella, MS4, Sidney Kimmel Medical College
2nd Prize, Poster: Much-Needed Vape-cation; A VAPI Case Presentation by Erin Torpey, MS4, Rowan College of Osteopathic Medicine
RESIDENT ABSTRACT AWARD WINNERS
Vignette Winner: Consider Gabapentin Toxicity with Acute Movement Disorders by Dan Hurley, PGY4, Emergency Medicine/Internal Medicine, ChristianaCare
Research Winner: Assessing the Impact of a Community Fire on Pediatric Emergency Department Visits for Respiratory-Related Diagnoses:
A Preliminary Report by Jonathan Li, PGY1, Medicine/Pediatrics, ChristianaCare
QI Winner: Improving Guideline-Based Opioid Prescribing Practices in Our Resident Continuity Clinic: A Quality PGY1, Internal Medicine, ChristianaCare
RESIDENT POSTER WINNERS Vignette Poster Winners
1st Prize, Poster: Crashing into
a Diagnosis: Neurocysticercosis, A Cause of New-Onset Seizure by Fazad Mohamed, PGY1, Internal Medicine, ChristianaCare
2nd Prize, Poster: DRESSed to Kill; When a Red Rash Is a Harbinger for Severe Drug Reaction by Andrew Pajak, PGY1, Internal Medicine, ChristianaCare
QI Poster Winner
1st Prize, Poster: Partnering with the Community for Diabetes Prevention by Jenna Laughlin, Chief Resident, Internal Medicine, ChristianaCare
ABSTRACTS OF COMPETITION WINNERS: MEDICAL STUDENTS
Abstract 1st Place
Granulomatosis with Polyangiitis: Early Disease Manifestations with Otologic Findings by Blake Shoemaker, MS4, PCOM Co-Authors: Esteban Mercado, PGY2; Robert DeGrazia, MD
Introduction: Granulomatosis with Polyangiitis (GPA) is an ANCA vasculitis that is known to involve the pulmonary, renal, and ENT systems. This diagnosis is hallmarked by its involvement of the ENT system, with otologic disease being an early manifestation of disease.
Case Description: A 52-year-old male with a history of 23lbs weight loss, decreased appetite, newly diagnosed anemia, and AKI presented to the ED after he was found to be anemic at a
PCP visit. In the emergency department, the patient was found to have an AKI with a creatinine of 3.62, anemia with hemoglobin of 7.1, and an ESR elevated to 94. A CT chest at this time revealed bilateral pulmonary nodules and sclerotic bone lesions of his third rib and right raised concern for malignant disease. Further discussion with the patient revealed that symptoms onset roughly six months prior. His initial symptomatology was constant ear pain, pressure, and hearing changes. This prompted an ENT referral and ultimately tympanostomy tube insertion. The patient then described a stable period, until four months prior
to this hospitalization, when he began
having diffuse joint pain. The joint
pain began in his hands and ultimately spread to encompass from his jaw to
his ankles. This prompted a workup by Rheumatology and led to the diagnosis
was treated with steroids. Finally, two months prior to this admission, the patient was referred to Urology for a workup of microscopic hematuria. This led to an unrevealing cystoscopy and treatment nose bleeds during this six-month period and approximately 12 episodes of chills. The presenting symptoms warranted
an extensive workup. Many laboratory studies proved unrevealing, with the his vasculitis panel. The patient was found to be positive for c-ANCA with elevated
were consistent with the diagnosis of granulomatosis with polyangiitis. Biopsy considered diagnostic. The patient was treated with three days of high-dose methylprednisolone and one dose of cyclophosphamide, with intention to transition to rituximab for treatment in the future.
Discussion: Granulomatosis with polyangiitis is an ANCA vasculitis with an incidence of 14.3 per 1 million persons per year. This diagnosis is hallmarked
by pulmonary, renal, and particularly ENT involvement. Early presentations
of this disease can often go undiagnosed or misdiagnosed for some time. Prompt diagnosis of the disease is important
as this is correlated with better long-
term outcomes and fewer relapses. This disease is usually due to c-ANCA directed against serum proteinase 3. While the pathogenesis of the disease is not fully known, there is evidence to suggest exposure to silica or colonization by certain staphylococcus aureus species
present in 73-93% of patients with GPA. 20-60% of patients will have otologic
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