West Florida Division Virtual Research Day

Featuring scholarly activity from HCA Healthcare Graduate Medical Education residents in the West Florida Division.

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Cutaneous Leishmaniasis in a Traveler: A Case Report

Sarah Al-Obaydi MD, Nemer Dabage MD, and James DeMaio MD

Leishmaniasis, a vector-borne infection transmitted by sandflies, is endemic throughout the Mediterranean basin and the tropics. We present a case diagnosed in Florida after overseas travel.
Pasteurella Multocida Bacteremia Secondary to Multiple Cat Scratches

Charles Boadu MD, Andrea Hernandez MD, Bassem Zeidan MD, John T. Young MD, and Johnathan Frunzi MD

Pasteurella multocida(P. multocida)is part of the normal gastrointestinal and upper respiratory flora of domestic and wild animals such as dogs, cats, rabbits, opossums, boars, tigers, lions and horses ^{(1, 2)}. Transmission of P. multocidais usually through scratches and bites leading to infections of the soft tissue and skin ^(3,4). P. multocida bacteremia is rare, but occurs in individuals with major risk factors including chronic pulmonary disease, diabetes mellitus, end state renal disease (ESRD), and an immunocompromised state ^(3,4). Non traumatic infections of P. multocida in immunocompromised individuals,are more likely to require care in the intensive care unit (ICU), likely to occur in patients with severe comorbidities, and are likely to end in mortality⁽⁴⁾. In this case, we present P. multocida bacteremia in an immunocompromised adult male with end stage kidney on hemodialysis.
Pneumonia: An Unexpected Graveyard Visitor?

Daniel A. Casas DO, Jigar Chauhan MD, Melanie Williams DO, Jan Sambataro MD, David Sukhai MD, Pablo G. Dubon MD, and Jorge Perez MD

Community acquired pneumonia caused by Influenza can present with superinfection. On rare occasions, an unexpected organism is discovered.
A Rare Case of Primary Cutaneous Mucoepidermoid Carcinoma

Hassie Cooper DO, Maheera Farsi DO, Richard Miller DO, Pay Kamrani, and Dudith Pierre Victor

Mucoepidermoid carcinoma (MEC) is a well-documented malignant tumor commonly found in the salivary glands. Cutaneous involvement is very rare, especially when presenting as a primary cutaneous neoplasm. Gallagher first described primary cutaneous MEC in 1959 and since then, to the best of our knowledge, there have been approximately 20 reports published in the literature. Here we present a very rare case of primary cutaneous mucoepidermoid carcinoma.
New Onset Psychosis Secondary to Neurosyphilis

Lauren Angela DeMarco DO, Samantha Linda Jane Vu DO, Francis Butler MD, and Nihal Shah MD

Syphilis is a highly contagious sexually transmitted infection (STI) caused by the spirochetal bacterium Treponema pallidum. Transmission occurs through direct contact of painless ulcerative lesions, chancres, located on the genitalia (penis, labia) and oral mucosa. Neurosyphilis is any involvement of the central nervous systems (brain, meninges, or spinal cord) by the bacterium.
Cervical Cancer Recurrence in the Colon

Samantha A. Erb DO, Shreyash Pandya MD, and Johnny Johnson MD

Cervical cancer is the fourth leading cancer worldwide in women, ranking only after breast cancer, colorectal cancer, and lung cancer. Because it is typically diagnosed at a younger age compared to other major cancer types, it leads to a proportionally greater loss in life-years. Most cancers occur in squamo-columnar junction, the transition point between squamous and columnar cells; squamous cell carcinoma accounts for approximately 70% of cervical cancer cases. Treatment options vary depending on the stage at diagnosis and include surgery (conization or hysterectomy), radiation, chemotherapy, targeted therapy, and immunotherapy. Prognosis is affected by stage, tumor volume, age and performance status, and treatment type.

Local recurrence of cervical cancer is not uncommon. It is known to metastasize to distance sites including the lung, liver, bone, and supraclavicular lymph nodes, with rare cases involving the breast, paraspinal muscles and duodenum. Metastatic spread of cancer from extracolonic origin to the colon is uncommon. It occurs very rarely in breast and lung carcinomas (~2%), as well as stomach, prostate, breast, ovarian and melanoma This is a care case of a recurrence of cervical cancer that spread to the colon and presented as a sigmoid lesion.
Carcinoid Syndrome Arising from the Descending Colon causing Carcinoid Heart Disease

Julien A. Exposito DO, Adam Salomon DO, Oliver Fowler DO, Christopher Cooke DO, Joelle Ellis MBBS, Patricia Chun DO, and Christiano Caldeira MD
An Atypical Presentation of Neuroleptic Malignant Syndrome

Rudy Forte MD, Shiwani Kamath MD, Debra Angelo MD, and Johnathan Frunzi MD

Neuroleptic Malignant Syndrome (NMS) is a rare, but potentially life threatening condition associated with dopamine blockade, particularly first-generation antipsychotics. The complex pathophysiology of NMS remains somewhat unclear and debatable as the symptoms are not fully explained by dopamine blockade alone.¹ D2 dopamine receptor antagonism remains responsible for most cases of NMS, however a few cases have been reported in which little to no D2 blockade activity was present.¹

This poster is about an atypical presentation of NMS.
Acral Lentiginous Melanoma: A Rare Variant with Unique Diagnostic Challenges

Taylor Gray DO, Brett Brazen, Maheera Farsi DO, and Richard Miller DO

Acral lentiginous melanoma (ALM), named for its location and histological growth pattern, is a rare variant of melanoma. ALM presents on palms, soles, or in association with the nail unit.1 While ALM accounts for approximately 5% of melanomas diagnosed each year, it is the most commonly diagnosed subtype of melanoma in non-Caucasian patients.
Teriparatide and its Bone Healing Power

Aneeta Joseph, Jesus L. Penabad MD, and Antonio Pinero-Pilona

Teriparatide, a parathyroid hormone analog, is an important anabolic agent approved by the U.S. Food and Drug Administration to increase bone mineral density in osteoporotic patients. Parathyroid hormone (PTH) regulates calcium, phosphate, and active vitamin-D metabolites. The amino terminal peptide fragments of PTH has been known to increase bone mass and are being used in clinical practice for osteoporosis management.3 Teriparatide increases bone density of lumbar spine and femoral neck, and decreases the risk of vertebral and non-vertebral fractures both in postmenopausal women and men. It is also known to prevent fractures in patients with osteoporosis and promote healing of fractures.
Fracture Blisters

Jessica Khabra MD, Jinal K. Patel MD, Gauthier L. Stepman MD, Kulveer Dabb MD, Kenny Hernandez MD, Debra Angelo MD, and Johnathan Frunzi MD

Fracture blisters are tense vesicles or bullae that develop on edematous skin following some acute long bone fractures. Fracture blisters are infrequently seen, as the reported incidence is 2.9% to 6.6%.¹ This rare complication, may not regularly be encountered by Physicians in the hospital. Fracture blisters typically occur within 24-48 hours following high energy trauma injuries & may last up to several weeks. Ultimately, this condition can lead to prolonged hospital stay due to an increased risk of infection and delay in surgical intervention.² Early recognition of this dermatologic complication may be helpful in reducing hospital stays.
Can Ulcerative Colitis Metastasis to the Skin? A Rare Case of Papulonecrotic Lesions Presenting as Cutaneous Ulcerative Colitis

Shiva Kheradmand, Guy Charest, David Esguerra, and Dudith Pierre-Victor

Skin manifestations in inflammatory bowel disease (IBD) can range from lesions that are reactive in nature, possess specific skin manifestations, or cutaneous disease secondary to malnutrition or malabsorption. Specific skin manifestations are cutaneous lesions which share with IBD the same granulomatous histopathological pattern. The lesions can be referred to as metastatic when they present at a site distal from the bowel. On the other hand, reactive skin lesions include erythema nodosum, pyoderma gangrenosum and Sweet’s syndrome which do not share the same histopathological findings but are believed to share a similar pathogenesis to IBD.
Evaluating Awareness of Low-Dose Computerized Tomography For Lung Cancer Screening

Roshni LeBoutillier DO, Bansi Savla MD, Vincent Wu DO, Zia Khan DO, Erick Mejia DO, Leah Tehranchi DO, My Myers MD, Khine Min MD, Jennifer Broyles MD, and Stacy Chase DO

In the U.S., excluding melanoma, lung cancer is the leading cause of cancer-related deaths.¹
Cigarette smoking is the number one risk factor and is linked to 80-90% of lung cancer deaths.²
Low-dose Computerized Tomography has been shown to reduce lung cancer deaths by 20% in randomized control trials and observational studies.⁴
The U.S. Preventative Task Force recommends annual screening for lung cancer with low-dose computerized tomography (LDCT) in adults ages 55-80 years of age who:
- Have a 30 pack-year smoking history and
- Currently smoke or
- Have quit within the past 15 years.
Hailey-Hailey Disease Successfully Treated with Low-Dose Naltrexone

John Moesch DO and Richard Miller DO

Hailey-Hailey disease (HHD) is an uncommon autosomal dominant disorder resulting from a mutation in the ATP2C1 gene resulting in dysfunction of the Golgi apparatus calcium-associated ATPase, thus interfering with intercellular calcium signaling.

HHD presents clinically as flaccid blisters and erosions in intertriginous areas, especially the axillae and groin.

The major histologic finding is acantholysis throughout the spinous layer of the epidermis, commonly referred to as a “dilapidated brick wall” appearance.

The initial lesions and associated symptoms usually develop during the second or third decade of life.

Complications of HHD include infections (bacterial, fungal, and viral), and malignant transformation (cutaneous squamous cell carcinoma).
Bilateral Posterior Fracture-Dislocation of the Proximal Humerus After First-Time Seizure

John D. Murphy DO, MBA; Phillip Braunlich DO; and Mohit Bansal MD

Fractures of the proximal humerus are commonly associated with osteoporosis and comprise 5.7% of all adult fractures [1]. Posterior dislocations of the shoulder comprise 2-5% of all shoulder dislocations, and when bilateral are even more infrequent, occurring less than 5%. [2,3]. Posterior dislocations are often associated with motor vehicle accidents, seizures, or electrical shock [4]. Fracture-dislocations of the proximal humerus occur in only 1% of all shoulder dislocations, thus making posterior fracture-dislocations off the proximal humerus exceedingly rare [5]. In this case report, we present a previously undescribed case presentation and treatment for bilateral posterior fracture-dislocations of the proximal humerus [7,8,9,10,11,12,13,14,15]. The purpose of sharing this case is to describe treatment options for a rarely encountered orthopedic trauma presentation, as there is currently a lack of existing medical literature.
Impact of Order Set Use on Stroke Care

Bilal Nadeem MD, Edward Waseleski DO, Meryem Maras-Casey MD, Sabih Alam MD, Adnan Faruqui MD, Michael Gutierrez MD, Maruthsakhi Molugu MD, Christina Oricompil MD, Ashar Mahmood MD, Katherine Torralba MD, Fatima Agha MD, Nour Tlimat MD, Olu Oyesanmi, Salman Muddassir MD, and Nikolay Mitzov MD

A case control study of 118 patients from Oak Hill Hospital between the months of August 2019 and January 2020 was recently completed for a hospital research quality improvement study. The objective was to determine if the use of either Hemorrhagic or Ischemic Stroke Order Set had an effect on the length of stay (LOS) or adherence to current stroke guideline recommendations when compared to its disuse. Results indicate use of either the Hemorrhagic or Ischemic Stroke Order Set led to a decreased length of stay and an increased adherence to current stroke guideline recommendations. Limitations of the study included non-adherence to the current 2019 stroke guidelines defined by The American Stroke Association .
Acute Hypoxic Respiratory Failure Due To Organizing Pneumonia With Lipoid/Cholesterol Component Caused By THC Vaping With E-Cigarette

Jinal K. Patel MD, Kiran Tirumalasetty MD, Jessica Khabra MD, Imran Khan MD, and Johnathan Frunzi MD

Vaping has been the new and deemed “safer” way to inhale addictive chemicals such as nicotine and tetrahydrocannabinol (THC), but it does not encompass the detrimental effects of other ingredients in these vaping cartridges that can cause lung injury[1,2]. Similar studies with dabbing (heating THC wax concentrate at high temperatures with butane) showcase rapidly progressing lung injury with massive consolidation and lasting effects on lung parenchyma over a period of time [3]. This case report aims to educate people, especially the younger generation, of the dangers of newer ways of combustible alternatives that have been marketed as a “safer” way to ingest addictive compounds. Here, we report a case of a patient with THC vaping with Electric-Cigarette causing Organizing Pneumonia with Lipoid Component.
Effect of an Electronic Order Set on Newborn Hepatitis B Immunization Rates

Daniel Pedersen, Angelina Rodriguez, Michael King, and Heather Schramm
Giant Splenic Artery Pseudoaneurysm Rupture Presenting as Hemorrhagic Shock

Jaya Sanapati MD, Parth R. Desai MD, Locke W. Barber DO, Johnathan Frunzi, and Timothy Lee MD

A 56-year-old Asian male was brought to the emergency department by first responders after he developed severe, sudden-onset headache and chest pain at his home. Past medical history was insignificant. On arrival to the emergency department, the patient was in respiratory distress. Vital signs revealed temperature of 36.0°C, blood pressure of 71/44, heart rate of 90 beats per minute, respiratory rate of 18 breaths per minute, and oxygen saturation of 95% with delivery of oxygen at 2 liters per minute via nasal cannula. Examination of the abdomen revealed diffuse tenderness. Laboratory findings and arterial blood gas analysis revealed normocytic anemia (hemoglobin 7.6 mg/dL) and an anion gap metabolic acidosis with low arterial pH (7.260) and elevated lactic acid (11.0 mg/dL).

Computed Tomography (CT) of the abdomen and pelvis revealed a splenic artery pseudoaneurysm, with cross-sectional area of 5.8 x 5.6 cm, and intra-abdominal fluid collections consistent with hemoperitoneum. The patient received transfusion of packed red blood cells and resuscitation with intravenous crystalloids. He subsequently underwent selective splenic artery arteriogram and coil embolization with resolution of pseudoaneurysm filling and extravasation. The following day, exploratory laparotomy with hematoma evacuation and intra-abdominal washout was performed. The patient was given the Haemophilus influenzae type B, pneumococcal, and meningococcal vaccines and discharged.
A Case Of Babesiosis Seen Outside Of Its Endemic Area And Outside Of Its Incubation Period

Kiran Tirumalasetty MD, Jinal K. Patel MD, Gauthier L. Stepman MD, Bassem Zeidan MD, K V. Sundaresh MD, Parth R. Desai MD, and Johnathan Frunzi MD

Babesiosis Microti is a parasitic alveolate that is usually transmitted by Ixodes scapularis ticks. In the United States, the endemic areas of Babesiosis include the Northeast and Upper Midwestern regions [1]. Symptoms include fever, malaise, fatigue, vomiting, and jaundice [1]. Current therapy primarily consists of a combination of azithromycin and atovaquone. Clindamycin and quinine may be administered in severe cases. For its emerging health risk worldwide, clinicians must be aware of the several presenting manifestations of babesiosis. Since 2017, the Centers Disease Control and Prevention (CDC) has deemed Babesiosis is a reportable disease. This case focuses on the importance of recognizing Babesiosis outside of its endemic area, and that was past the average incubation period associated of 1-9+ weeks.
Segmental Neurofibromatosis: Isolated Eruption of Neurofibromas on the Scapula in a Middle-Aged Man

Christopher White DO, Brett Brazen, and Richard Miller DO
Malignant Degeneration of Spiradenoma of the Eyebrow

Christopher White DO, Kristin Witfill DO, and Richard Miller DO

Spiradenocarcinoma is a malignancy of eccrine origin, with only 120 reported cases in the literature.¹ Elderly males and females are equally affected.² Benign spiradenomas along with their malignant counterpart are more frequent in patients with Brooke-Spiegler syndrome or familial eccrine spiradenoma, owing to the increased incidence of folliculosebaceous-apocrine tumors seen with these entities.³