Auburn Research Day 2021

Cl i n i ca l Case Repor t | Med i ca l St udent Association of COVID-19 with Spontaneous Pneumomediastinum

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Spontaneous Pneumomediastinum is a rare complication of COVID-19. A study conducted in Guiyang, China concluded that 7.14% of their patients with COVID-19 pneumonia developed a spontaneous pneumomediastinum. In another study with 976 COVID-19 patients, it was found that there were five cases of spontaneous pneumomediastinum and two cases of a spontaneous pneumothorax. This case can help support the development in the understanding of the association between COVID-19 and spontaneous pneumomediastinum. A 55-year-old male with PMHx of T2DM, anxiety, prior DVT was admitted to the hospital for acute hypoxic respiratory failure due to COVID-19 pneumonia. He had tested positive for COVID three days prior to the hospital admission. The patient’s hospital course was complicated by increasing oxygen demands, which was managed with Bi-PAP. His WBC increased overnight and repeat CXR showed worsening of the bilateral lower lobe opacities, indicating worsening of his pneumonia. After ten days Mary Klacik OMS III; Ankit Tzivion, MD; Kashyap Patel, MD LewisGale Medical Center, Salem, VA

in the hospital a CT scan showed a pneumomediastinum. The patient was then taken off BiPAP and placed on high flow nasal cannula and non rebreather mask. His oxygen saturations were labile and the patient was transferred to the ICU and was intubated. Previous studies have suggested that there is an association with SARS- CoV-2 with an air leak as a complication in no relation to intubation or positive pressure ventilation. The CT findings of the patients with a spontaneous pneumomediastinum consisted of diffuse airspace disease with ground glass opacities. This patient’s spontaneous pneumomediastinum can be explained by the association between COVID-19 leading to an acute lung injury and eventually a spontaneous air leak. It is suggested that peribronchiolar abscess formation probably leads to interstitial pulmonary emphysema, which tracks along the bronchovascular sheath and reaches the mediastinum. At that point the chest CT shows a spontaneous pneumomediastinum.

Cl i n i ca l Case Repor t | Med i ca l St udent Bilateral Isolated Choroidal Melanocytosis 005

Lauren Mason, MBA; John O. Mason III, MD University of Alabama-Birmingham, Department of Ophthalmology; Retina Consultants of Alabama

Background: Bilateral Isolated Choroidal Melanocytosis is a rare condition in which the patient presents with patches of melanocytic hyperpigmentation of the choroid but is otherwise asymptomatic. The case described here is particularly unique

because it examines both the youngest patient and only African American seen with bilateral isolated choroidal melanocytosis. We describe the case in further detail, as well as offer implications for management of the condition. *This case report was published in Retina Cases Brief Reports PMID: 26200387 Case Report: A 24-year-old African American female with no prior medical history and no visual complaints was referred for bilateral pigmentation of posterior pole. On examination, visual acuity was 20/30 bilaterally, and the patient had normal intraocular pressures. There was no vitiligo, uveitis, skin or sclera pigmentation, or systemic malignancy, and the anterior segment was normal. The right eye exhibited darkly pigmented lesions that were flat. The hyperpigmentation had feathered margins that measured roughly 8 clock hours. The left eye also exhibited darkly pigmented lesions that were flat. The hyperpigmentation in the left eye also had feathered margins but measured much smaller at just 3.5 clock hours. Wide field color photographs revealed bilateral choroidal pigmentation (Figure 1, Figure 2). The optical coherence tomography (OCT) (Figure 3, Figure 4) was remarkable for increased choroidal thickness with a normal inner and outer retina, while the B-scan ultrasonography was normal. In conclusion, we describe the youngest patient reported with bilateral isolated choroidal melanocytosis, as well as the first African American to have this diagnosis. We recommend longer follow up of our patient and the other four patients described in the literature, which will help elucidate the best term for this rare condition, as well as demonstrate whether these lesions can enlarge or have an increased risk of developing uveal melanoma.

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2021 Via Research Recognit ion Day