- |||||||||| ampicillin/sulbactam / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
Miller Fisher Syndrome and Respiratory Failure (Walter E. Washington Convention Center, Area G, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8659;
During evaluation, it is useful to investigate pulmonary physiology with NIMV. In our case, normal flow parameters, absence of significant leak, and low tidal volumes with our patient triggering all breaths raised suspicion for acquired neuromuscular weakness.
- |||||||||| remdesivir / Generic mfg., dexamethasone / Generic mfg.
Post-COVID-19 Pulmonary Fibrosis: A Case Report (Walter E. Washington Convention Center, Area G, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8652;
Comprehension of the disease course and risk factors involved is essential because residual scarring may lead to reduced quality of life. The role of antifibrotic therapies is based on changes in clinical status, radiographic progression, and decline in DLCO and FEV1.
- |||||||||| epinephrine / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
When Food Takes Your Breath Away: Ingestion of an Allergen Manifesting as Pneumonitis (Walter E. Washington Convention Center, Area G, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8633;
This case illustrates the importance of recognizing the ingestion of an allergen as an important but rare etiology that can play an important role in the pathophysiology of lung disease. Because of infrequent presentation and limited literature, guidelines on management are deficient and require further investigation.
- |||||||||| budesonide/formoterol / Generic mfg., nintedanib / Generic mfg.
Can Chronic Silent Micro-Aspirations Be the Culprit?: Achalasia Induced Interstitial Lung Disease (Walter E. Washington Convention Center, Area G, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8632;
Symbicort did not improve her symptoms...Nintedanib 150mg two times a day was added a year ago with evidence of fibrotic change to hopefully delay progression.Aspiration has long been considered a cause of lung disease...Our case serves as a reminder to all clinicians to remember esophageal diseases, including achalasia and other causes of recurrent aspiration as a part of their differential in patients with pulmonary fibrosis. This is an important entity to rule out, especially if patients are being considered for transplantation.
- |||||||||| AB1000 / Alveolus Bio, Veramyst (fluticasone furoate nasal spray) / GSK
Live Biotherapeutic Performs at Par With Steroids in Reducing Neutrophilic Inflammation in Models of COPD (Walter E. Washington Convention Center, Area D, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8521;
Neutrophilic inflammation in models of COPD can be mitigated by the administration of live biotherapeutic AB1000. Live bacteria strains delivered to the lungs may have a direct therapeutic benefit potential in high inflammation COPD.
- |||||||||| cefepime hydrochloride / Generic mfg., levofloxacin / Generic mfg., hydrocortisone / Generic mfg.
Legionnaires Disease Manifesting as an Acute Leukemoid Reaction (Walter E. Washington Convention Center, Area C, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8465;
Live bacteria strains delivered to the lungs may have a direct therapeutic benefit potential in high inflammation COPD. Despite treatment with cefepime, cessation of hydrocortisone, and liberation from mechanical ventilation by day 7 of hospitalization, the patient's white blood cell count peaked at 64,000 on day 8 of hospitalization...Legionella urine antigen then returned positive, and the patient was started on levofloxacin...However, an acute leukemoid reaction is rarely described in the literature in association with Legionnaires
- |||||||||| No Kidding, Nocardia? (Walter E. Washington Convention Center, Area C, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8459;
He was maintained on lenalidomide and dexamethasone until three months prior when he started experiencing diarrhea, weight loss, fatigue and intermittent fevers...He was treated with amoxicillin-clavulanate for 28 days without improvement...He was started on trimethoprim-sulfamethoxazole and minocycline with anticipated twelve-month course...As the rate of HCT increases in the United States, it is important to recognize opportunistic, latent and community acquired infections as a possible cause of lung masses. A timely diagnosis of nocardiosis is important in HCT patients as the one-year mortality has been reported as high as 40%.
- |||||||||| Decadron (dexamethasone) / Merck (MSD)
Disseminated Nocardiosis in an Immunocompetent Patient (Walter E. Washington Convention Center, Area C, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8458;
Our patient was initially treated with combination antimicrobial therapy, including meropenem for three weeks, rifampin for six weeks, and trimethoprim-sulfamethoxazole for six months. He was also placed on a long taper of decadron due to the brain abscess and frontal lobe edema...We believe our patient
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
Complete Resolution of Lung Cavitary Mass Following COVID-19 Infection (Walter E. Washington Convention Center, Area C, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8415;
Our case differs from other case reports in that we were able to follow up the natural radiographic progression of the cavity up to its complete resolution. This case shows that cavitary lesions in patients with COVID-19 are not always secondary to superimposed mycobacterial, fungal, or bacterial infections.
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
COVID-19 Pneumonia Complicated by Pulmonary Embolism and Delayed Empyema (Walter E. Washington Convention Center, Area C, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8412;
She was successfully extubated after 13 days of mechanical ventilation but developed post-extubation stridor and aspiration that required reintubation, additional 4 days of mechanical ventilation.Hospital course further complicated by deep vein thrombosis and bilateral pulmonary embolisms noted on hospital day 28, status-post therapeutic enoxaparin which was transitioned to apixaban...It is likely that the empyema was related to superimposed bacterial pneumonia. Pulmonary embolisms on the other hand have been well described in literature, despite use of DVT prophylaxis patients can still develop DVT/PEs due to the prothrombotic state associated with COVID-19.For patients with severe COVID-19 pneumonia, clinicians should be diligent with all types of complications including pulmonary embolism and empyema.
- |||||||||| Olumiant (baricitinib) / Incyte, Eli Lilly
Spontaneous Pneumothorax Following COVID19 Infection With Recurrent Respiratory Failure (Walter E. Washington Convention Center, Area C, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8408;
Spontaneous pneumothorax after recovery from COVID-19 infection is extremely rare. Given its increased mortality and poor outcome, clinicians should be wary of the condition as a possible cause of sudden respiratory failure in patients with recent diagnosis of COVID.
- |||||||||| dexamethasone / Generic mfg.
Neonatal Presentation of Hermansky Pudlak Type 2 Lung Disease (Walter E. Washington Convention Center, Area H, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8265;
Dexamethasone was administered, with subsequent extubation from oscillator to CPAP with FiO2 28%...Severe presentation in infancy affords opportunity to study the disease at its earliest stages, before development of the fibrosis that typically characterizes HPS-associated lung disease. Our case provides pathogenetic insight into the inciting basis of lung disease in HPS type 2, helping to establish surfactant protein dysfunction as a component of lung disease development.
- |||||||||| Kineret (anakinra) / SOBI
Post-COVID-19 Bronchiolitis Obliterans in a Neonate (Walter E. Washington Convention Center, Area H, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8243;
While there have been several case reports of post-COVID-19 BO in pediatric patients, it has not been described following neonatal infection. This case also demonstrates the utility of anti-inflammatory medications in COVID-19 BO to decrease ongoing inflammation and stabilize pulmonary function.
- |||||||||| dexamethasone / Generic mfg., daunorubicin / Generic mfg., vincristine / Generic mfg.
Intratracheal T Cell Lymphoma: A Case Report (Walter E. Washington Convention Center, Area H, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8233;
Intratracheal involvement of anterior mediastinal tumors is rare, particularly in pediatric cases. Prompt bronchoscopy evaluation and multidisciplinary management as in this case can lead to successful outcomes in the case of severe airway obstruction.
- |||||||||| remdesivir / Generic mfg., dexamethasone / Generic mfg., prednisone / Generic mfg.
Vaping Associated Pulmonary Injury, A Case During the COVID-19 Pandemic in United States (Walter E. Washington Convention Center, Area E, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8207;
The patient was started on Dexamethasone and Remdesivir for COVID-19 Pneumonia...The repeat CT scan showed significant improvement and she was discharged home on tapering doses of prednisone...The burden of disease is confined to young population as well as older generation, and the rising case numbers make it imperative for environmental public health to halt the production and spread of harmful vaping products in the market. As a physician, we need to consider the disease in all patients presenting with acute lung injury especially in the COVID-19 era and also raise the awareness among our patients to switch to right material while quitting smoking.
- |||||||||| prednisone / Generic mfg.
Synthetic Marijuana Small Airways Injury Responds to Pulse Methylprednisolone and Prolonged Prednisone Taper (Walter E. Washington Convention Center, Area E, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8200;
At the completion of his treatment he reported no pulmonary symptoms and pulmonary function testing demonstrated mild obstruction without significant bronchodilator response, resolution of prior air trapping, and normal diffusion capacity.DISCUSSIONWe report a rare case of severe organizing pneumonia with fibrous obliteration of small airways associated with surreptitious marijuana use and the effective treatment of this entity with pulse methylprednisolone and prolonged prednisone taper. Pulmonary toxicity associated with marijuana use can mimic other conditions and correct diagnosis and treatment are of great importance.
- |||||||||| Breztri Aerosphere (budesonide/formoterol fumarate/glycopyrronium) / AstraZeneca
A Case of Hyphae-hypersensitivity (Walter E. Washington Convention Center, Area E, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8198;
He had a dry cough, 40 pound weight loss, and symptoms were unresponsive to a Breztri inhaler prescribed by his PCP...An individual working as a landscaper is exposed to numerous antigens: pollens, fungus, birds, and numerous other antigens which have yet to be identified as inciting an immune response in the patient. Older age and being unable to identify an antigen are associated with higher rates of mortality and it is therefore critical to identity antigens in a timely manner so treatment can be initiated promptly and permanent, fibrotic changes do not occur.
- |||||||||| Raided Lungs (Walter E. Washington Convention Center, Area E, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8197;
Dexamethasone was started due to suspicion for COVID, with ceftriaxone and azithromycin for community acquired pneumonia...She was re-initiated on methylprednisolone at 1mg/kg, with improvement over 4 days, and subsequently discharged on a 4 month prednisone taper...Hypersensitivity pneumonitis occurs with irritant exposure, but tends to involve the upper lobes. Further studies need to investigate the causal relationship of pyrethoids with lung toxicity.
- |||||||||| Dulera (mometasone/formoterol) / Merck (MSD), Novartis
Asthma With Pneumonia Secondary to Influenza (Walter E. Washington Convention Center, Area E, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8184;
Dulera and prednisone 40 mg for 5 days treated the asthma...Estimating Influenza-associated deaths in the United States. AJPH 2009;99:S225-S230.
- |||||||||| remdesivir oral (GS-5734 oral) / Lupin
A Rare Case of Eosinophilic Pneumonia Precipitated by E-cigarette Presenting as a COVID-19 Mimic (Walter E. Washington Convention Center, Area E, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8183;
Day 2, steroid was transitioned to oral, Remdesivir was discontinued...However as evidenced in this case, rapid steroid initiation remains the mainstay of treatment in these patients with complete resolution. Our case highlights that AEP and EVALI should be considered in the differential for AHRF in a previously young healthy patients, especially as vaping has increased significantly in recent years.
- |||||||||| fexofenadine / Generic mfg., dexamethasone injection / Generic mfg., epinephrine / Generic mfg.
A Curious Case of Croup: Parainfluenza Positive Laryngotracheobronchitis in an Adult (Walter E. Washington Convention Center, Area K, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8133;
She felt this could be related to seasonal allergies and took fexofenadine with mild improvement of her sore throat...Given the history of croup as a child, findings on x-ray, and a Westley croup score of 5 indicating moderate severity, the patient was immediately treated with racemic epinephrine and intravenous dexamethasone and admitted to the ICU for airway monitoring...The case highlights the need for clinicians to be aware of croup as a differential in adults presenting with dyspnea, cough, or stridor. Early diagnosis with a flexible laryngoscope and close clinical monitoring can prevent escalation of care and result in a favorable outcome.
- |||||||||| vancomycin / Generic mfg., ampicillin / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
Enterococcus Faecalis Bacteremia: The Driving Force Behind Septic Thrombophlebitis and Cavitary Pneumonia (Walter E. Washington Convention Center, Area K, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8109;
Early diagnosis with a flexible laryngoscope and close clinical monitoring can prevent escalation of care and result in a favorable outcome. She was started on intravenous methylprednisolone and nebulized therapy...Patient was started on vancomycin and her central line was removed...Blood cultures eventually revealed E. faecalis, and antibiotic regimen was changed to ampicillin based on culture
- |||||||||| Mycamine (micafungin) / Astellas
Disseminated Coccidioidomycosis in a Patient With Acute Promyelocytic Leukemia and Suspected Differentiation Syndrome (Walter E. Washington Convention Center, Area K, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8094;
Vancomycin and piperacillin-tazobactam were also initiated...Antibiotics were broadened to vancomycin, meropenem, and micafungin...Our case highlights the importance of a high index of suspicion for coccidioidomycosis in immunocompromised patients from endemic regions. Failure to recognize and treat in a timely fashion can prove fatal.
- |||||||||| Acute Epiglottitis Caused by Gastric Acid From Protracted Vomiting (Walter E. Washington Convention Center, Area K, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8067;
There are no reported cases of epiglottitis caused by injury from acidic gastric contents from protracted vomiting, though the mechanism is presumably similar to that of caustic ingestion. In such patients, the presence of stridor, respiratory distress, dysphagia, odynophagia, and drooling should immediately prompt evaluation for epiglottitis to avoid progression to airway compromise.
- |||||||||| dexamethasone injection / Generic mfg.
Intraoperative Development of Severe Euglycemic Ketoacidosis in a Non-diabetic Patient (Walter E. Washington Convention Center, Area K, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8049;
Intraoperatively she received dexamethasone 10 mg IV x 2 (first dose early in case), 5% albumin 100g, lactated ringers 1L, normal saline 1L, and sodium bicarbonate 50 mEq (one ampule) without significant improvement (repeat ABG 7.16/23)...Though surgery is known to trigger euDKA, to our knowledge such severe perioperative acidosis from euDKA in a non-diabetic patient has not been previously reported. Intensivists and anesthesiologists should recognize euDKA as a potential cause of severe perioperative acidosis in non-diabetics with risk factors.
- |||||||||| prednisone / Generic mfg., thyroxine / Generic mfg., hydrocortisone / Generic mfg.
Bilateral Pleural Effusion Secondary to Myxedema (Walter E. Washington Convention Center, Area K, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8045;
The mainstay of treatment is correction of the hormonal imbalance with intravenous thyroid hormone and hydrocortisone in an ICU setting. Studies have reported a mortality rate of as high as 60% therefore making an early diagnosis crucial for a positive patient outcome.
- |||||||||| Pituitary Apoplexy, A Rare But Life Threatening Complication of Pituitary Adenoma (Walter E. Washington Convention Center, Area K, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8042;
Pituitary apoplexy is a rare but serious complication of pituitary adenoma associated with significant mortality and morbidity...Transsphenoidal resection of the pituitary gland is the surgical intervention of choice for patients presenting with neuro-ophthalmological findings. Rapid diagnosis, medical stabilization, and early surgical decompression will be lifesaving and will result in better neurological outcomes.
- |||||||||| methimazole / Generic mfg., hydrocortisone / Generic mfg., amiodarone / Generic mfg.
Thyrotoxic Periodic Paralysis: A Grave Disease (Walter E. Washington Convention Center, Area K, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8041;
CRRT was initiated due to low urine output and Patient was started on Methimazole due to elevated liver enzymes due to shock liver and Hydrocortisone...Slow potassium replacement is considered to be the mainstay of treatment with the danger of rebound hyperkalemia. Definitive treatment includes anti-thyroid medications, surgical thyroidectomy or radioiodine therapy until euthyroid state is achieved.
- |||||||||| Olumiant (baricitinib) / Incyte, Eli Lilly
A Bug Problem: Increased Incidence of Infections With Baricitinib Administration in Critically Ill Patients With COVID-19 (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8034;
In our institution we switched the immunomodulatory treatment of COVID from Tocilizumab to Baricitinib when the former became unavailable in late 2021...All studied patients received at least 10 days of steroids (most commonly dexamethasone), with half of the patients receiving additional doses for treatment of suspected organizing pneumonia...Which the two seminal large trials of the medication for this indication show both a low, and no added risk for infection, our experience suggests that the actual risk of infection in a real-world setting may be much higher. Confirmation of these findings requires an adequate case-controlled study (in progress) and expansion to multiple sites.
- |||||||||| Comirnaty (tozinameran) / Pfizer, Fosun Pharma, BioNTech, Actemra IV (tocilizumab) / Roche, JW Pharma
A Healthy 27-year-old Multiparous Patient at 27 Weeks (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8031;
Three weeks following her diagnosis she received her first dose of the BNT162b2 mRNA vaccination...Her echocardiogram showed a newly reduced left ventricular ejection fraction to 40% and clinical evidence of cardiogenic shock requiring initiation of dobutamine...She was recovered in the ICU with diuresis, 162 mg of aspirin, 1 mg/kg of methylprednisolone following dexamethasone for fetal lung maturity, one 400 mg dose of tocilizumab, and intravenous immunoglobulin 1mg/kg for two doses with guidance from our interdisciplinary MIS-A team. This case highlights clinical features of MIS-A in a healthy pregnant woman at 27 weeks
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
Peripartum Pneumoperitoneum and Pneumoretroperitoneum in COVID-19 (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8030;
Patients with COVID-19 are at increased risk of barotrauma and should be monitored for such complication. For patients in respiratory distress requiring mechanical intubation, ECMO should be considered as an intervention for lung rest strategy to reduce further barotrauma.
- |||||||||| Acute Epiglottitis Due to Serratia Marcescens in the Setting of SARS-CoV-2 Infection in an Immunocompetent Patient (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8027;
Although the incidence of AE is decreasing, a high suspicion index is required in patients presenting with high-grade fever, drooling, and voice hoarseness. Early management initiation with broad antibiotics coverage, decreasing intubation threshold, and possibly adding pulse steroids and Racemic Epinephrine might decrease mortality and morbidity.
- |||||||||| A Life-Threatening Combination: A Case of Burkholderia Gladioli Pneumonia in a Patient With Coronavirus Disease 2019 (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8022;
Non-invasive positive pressure ventilation was initiated and he was treated with remdesivir, convalescent plasma, dexamethasone as well as empiric ceftriaxone and azithromycin...Antibiotics were broadened to cefepime and vancomycin at that time...Antibiotic therapy was adjusted to empiric piperacillin/tazobactam and nebulized tobramycin, however, the patient's family elected to proceed with hospice care prior to the availability of the B gladioli sensitivity report...In one other case, the patient succumbed to this illness. We believe that this case adds to the existing literature to shed light on the significant morbidity and mortality this infection can have on patients with COVID-19.
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
Patient With COVID-19 Pneumonia Treated With Steroids and Tocilizumab is Diagnosed With AIDS (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8020;
The early phase of the COVID-19 pandemic included research to guide treatment, and the literature showed dexamethasone decreased mortality...He tested positive for HIV with a CD4 count of 16 and was started on TMP-SMX, steroids, and fluconazole...The patient received beyond the recommended course of steroids, which may have contributed to his clinical decline given his underlying immunocompromised state. At the case site, order guidance has been reviewed to optimize steroid stewardship, especially in complex cases like these.
- |||||||||| remdesivir / Generic mfg., hydrocortisone / Generic mfg.
A Case Series of Persistent SARS-CoV-2 Infection in Immunocompromised Pediatric Patients (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8017;
Multiple therapeutic agents were used in their COVID-19 management, including corticosteroids, remdesivir, and monoclonal antibodies. All three patients whom have received concurrent therapy with Remdesivir, Hydrocortisone and Monoclonal Antibodies has survived, only one patient has died as a direct complication of COVID-19 ARDS with secondary pulmonary Mucormycosis; Our outcomes suggests the potential benefit of Remdesivir use in combination with Hydrocortisone and Monoclonal Antibodies in the management of severe COVID-19 ARDS in this group, as well as the importance of early administration of broad empirical antimicrobial coverage, including antifungal coverage, given the higher risk of secondary bacterial and fungal infections.
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma, Soliris (eculizumab) / AstraZeneca
Pressure Ulcers in the Prone Ventilated Critically Ill Patient With COVID-19 (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8010;
These case series illustrate and hypothesize that patients with COVID-19 requiring mechanical ventilation in a prone position are at an increased risk for pressure ulcer development from the positioning changes process and the hyperinflammatory state intrinsic to the infection and require frequent skin surveillance. Preventative solutions to decrease shearing forces between the skin and devices should be considered and specific guidelines for prone positioning implemented.
- |||||||||| Post COVID Pneumonia Complicated by Secondary MRSA Empyema (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8009;
Sputum culture grew MRSA, and the patient was started on vancomycin...Secondary bacterial infections lead to higher morbidity and mortality rate. Early recognition with appropriate surgical and medical intervention in our patient resulted in successful recovery.
- |||||||||| Kineret (anakinra) / SOBI
Early Recognition of Idiopathic Hemophagocytic Lymphohistiocytosis Complicated by Intracranial Hemorrhage, A Case Report (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8004;
In our case, this led to the unfortunate outcome of terminal intracranial hemorrhage, a complication that has been mentioned in only a few case reports but is a deadly sequelae of disease. Our case suggests the importance of more rigorous monitoring and aggressive correction of coagulopathies to prevent secondary sequelae of HLH which remain life threatening despite an improvement in the underlying disease process.
- |||||||||| A Rare Case of Herpes Simplex Virus Type1 Induced Hemophagocytic Lymphohistiocytosis in Adult Patient (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_7993;
We present an additional case of HSV-1 as an etiology of HLH.Case description: 66-year-old male with a past medical history of gastric adenocarcinoma status post total gastrectomy, on fluorouracil, leucovorin, oxaliplatin, docetaxel and trastuszumab recent diagnosis of typhilitis treated with levofloxacin and metronidazole presented with abdominal pain, diarrhea, and poor intake...He was started on antibiotics which included cefepime, vancomycin, and doxycycline...The patient was started on IV acyclovir and continuous renal replacement therapy given continued decompensation of renal function...Treatment would consist of etoposide, dexamethasone or methotrexate in addition to supportive care via blood product transfusions and treatment of underlying etiology. Literature review showed mostly pediatric case reports of HSV-1 induced HLH but rarely was it described in the adult population.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
Hemophagocytic Lymphohistiocytosis (HLH) Diagnostic Dilemma: Ehrlichiosis or EBV? (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_7992;
Rituximab was also added given the concomitant concern for HLH secondary to EBV...EBV-driven HLH, however, warrants steroids and chemotherapy agents that are not well-tolerated in the ICU. Thus, it is imperative to identify the preliminary cause of HLH, keeping in mind that EBV could be reactivated in an HLH patient and act as a confusing diagnostic decoy.
- |||||||||| Hemophagocytic Lymphohistiocytosis Secondary to Infected Staghorn Renal Calculus (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_7991;
High degree of suspicion of HLH is required because of variable clinical presentations, lack of specificity of clinical and laboratory findings, and diversity of causes. In the case presented prompt recognition of HLH syndrome secondary to underlying pyelonephritis was critical to start appropriate treatment with etoposide and dexamethasone following which the patient had significant clinical improvement.
- |||||||||| Postpartum Hemophagocytic Lymphohistiocytosis (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_7990;
Pregnancy has only rarely been associated with HLH in case reports with the overwhelming majority occurring prior to delivery. This case highlights that while pregnancy may be a trigger for HLH, delivery does not resolve this risk and HLH should be considered in the immediate postpartum period.
- |||||||||| Decadron (dexamethasone) / Merck (MSD)
An Unusual Cause of Thrombocytopenia By Commonly Used Over the Counter Phenazopyridine (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_7981;
Phenazopyridine was discontinued, patient received platelets and was started on IVIG with decadron 40 mg for 4 days.DITP can be a result of three different processes including direct injury to the bone-marrow consequently affecting its thrombopoietic function, immune-mediated process with the antibody production and formation of Hapten...Systemic corticosteroids are highly efficacious with response in up-to 90% of cases given their anti-inflammatory and thrombopoietic effects. Our patient required platelets, systemic corticosteroids and IVIG administration with good response.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
A Rare Case of Evans Syndrome With Antiphospholipid Antibodies and RSV Infection (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_7975;
Secondary ES has been reported to be associated with non-Hodgkin lymphoma, autoimmune disease, infections, primary immunodeficiencies and pregnancy...Also, RSV with antiphospholipid antibodies is very rare. Our patient presentation is probably because of viral antigenic mimicry and cross-reactivity with host phospholipid-binding protein b2 glycoprotein I?.
- |||||||||| gemcitabine / Generic mfg.
Intraperitoneal Absorption of Intravesical Gemcitabine Resulting in ARDS and Pancytopenia (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_7952;
The patient received 5 units of platelets, 1 unit of packed red blood cells, filgrastim, methylprednisolone, and intravenous immunoglobulin (IVIG) for thrombocytopenia down to a nadir of 4 K/mcL. Although IVC gemcitabine is considered to have a favorable safety profile in the treatment of urothelial carcinoma, potential intraperitoneal absorption was the likely cause of this patient
- |||||||||| An Adverse Reaction to Coral Snake Antivenom (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_7941;
Patients should be closely monitored in an ICU setting for adverse reactions including anaphylaxis during and after antivenom administration. Timely identification and management of adverse reactions is crucial in order to administer the complete and effective antivenom dose.
- |||||||||| Dupixent (dupilumab) / Sanofi, Regeneron
The Role of Dupilumab in Refractory Anaphylaxis Secondary to Food Allergy (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_7937;
IL4 and IL13 inhibition may have played a role in the resolution of this patient laryngeal edema. CONCLUSION This highlights a rare case of refractory anaphylaxis improvement with Dupilumab.
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