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T, Miyaji H, Tamamura H, Yamada M b . The Efficacy of Radiation Monotherapy for Tolosa- Hunt Syndrome. Journal of Neurology. 2010; 257(2):288. Epub 2009 Oct 1. https://link. springer.com/content/pdf/10.1007/s00415- 009-5335-8.pdf. Accessed on July 28, 2019.
Halabi T, Sawaya R. Successful Treatment of Tolosa-Hunt Syndrome after a Single Infusion of Infliximab. Journal of Clinical Neurology. 2018; 14(1):126. https://thejcn.com/ DOIx.php?id=10.3988/jcn.2018.14.1.126. Accessed July 28, 2019.
Kline, LB; Hoyt, WF. The Tolosa-Hunt Syndrome. Journal of Neurology, Neurosurgery & Psychiatry. 2001 Nov; 71(5):577-82. https://jnnp.bmj.com/content/71/5/577.long Accessed on April 21, 2019.
Tolosa-Hunt Syndrome. In: Lee S, ed. UpToDate. Waltham, Mass.: UpToDate, 2019. https://www-uptodate-com.ezproxy.pcom. edu/contents/tolosa-hunt-syndrome?source =autocomplete&index=0~1&search=tolos. Accessed April 14, 2019.
Student Poster, 1st Prize
A Tale of Two Pathogens by Nicole Scaramella, MS4, SKMC Co-Author: Chad Duffalo, MD, Infectious Disease and Internal Medicine, ChristianaCare
Case Presentation: A 64-year-old male with a past medical history of alcohol abuse had associated weight loss and a productive, non-purulent, non-foul-smelling chronic cough. On physical exam, he was afebrile, tachycardic, and normotensive and his oxygen saturation remained above 95%
on room air. He was an ill-appearing man with bitemporal wasting, poor dentition, and a normal heart and lung exam. His
disorientation to time, expressive aphasia,
of 12.4 with a neutrophilic predominance
of 83.7%. CT head non-contrast showed
a mass in the left occipital-parietal region measuring 3.9cm x 2.1cm in diameter with associated vasogenic edema. Intravenous dexamethasone was started due to cerebral edema. Chest radiograph showed a cavitary lesion in the right apex. CT Chest with contrast showed a right upper-lobe bulla
with soft tissue density and peripheral gas concerning for an aspergilloma. Bacterial and fungal blood cultures and sputum cultures were collected. Fungitell glucagon levels, Aspergillus fumigatus IgG antibodies, Aspergillosis galactomannan antigen, and HIV antibodies were collected. MRI with contrast showed a necrotic lesion in the left parieto-occipital region that was concerning for an abscess. He underwent a left craniotomy and evacuation. Aspirate cultures of the abscess were collected, dexamethasone was discontinued postoperatively and
he was started on imipenem-cilastatin, metronidazole, vancomycin, and voriconazole. Transthoracic echocardiogram was negative for valvulopathy or vegetation. Endobronchial ultrasound bronchoscopy was showed Aspergillus. Blood cultures, sputum cultures, AFB, and HIV 1 and 2 antibodies were negative. The abscess aspirate grew fusobacterium nucleatum. Fungitell glucan was positive with >500pg/ml reported. Aspergillus Galactomannan Ag was positive. Aspergillus IgG Ab was positive with 185mg/L. His antibiotics were narrowed to six weeks of ceftriaxone and metronidazole for his Fusobacterium nucleatum brain abscess. Voriconazole was to be continued for six months for his invasive chronic pulmonary aspergillosis infection.
Discussion: This case emphasizes the importance of considering two possible pathogens as the cause of separate infection sites. By collecting aspirations of each site involved, the diagnosis and proper treatment
for each infection was made rather than the incorrect assumption that there was one unifying cause of infection.
Also, this case represents complete diagnostic testing for invasive aspergillosis specimens are preferred for diagnosis of invasive aspergillosis as were sent in this case. Galactomannan is also an accurate marker for invasive aspergillosis. Serum not be used alone for diagnosis. Elevated
the diagnostic criteria for chronic cavitary pulmonary aspergillosis.
CONTRIBUTOR
■ Nicole Scaramella is a fourth-year medical student at Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia.
References:
Patterson, T., Thompson, G., Denning, D., Fishman, J., Hadley, S., Herbrecht, R. ... Bennett, J. (2016). Executive Summary: Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 63(4), 433–442. https://doi.org/10.1093/cid/ciw444.
Student Poster, 2nd Prize
Much-Needed Vape-cation; A VAPI Case Presentation by Erin Torpey, MS4, Rowan College of Osteopathic Medicine
Co-Authors: Soraya B. Bascoy, MD, ChristianaCare
Introduction: Vaping-associated pulmonary injury (VAPI) is a potentially life-
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