Louisiana Research Day Program Book 2025

Case Studies: Section 1

Case Studies: Section 1

Maham Khan, OMS-III; Randolph Devereaux, PhD as the research mentor 1 VCOM-Louisiana; 2 Brentwood Psychiatric Hospital 86 INTERSECTIONS OF CHRONIC ILLNESS AND MENTAL HEALTH: A CASE OF SICKLE CELL DISEASE AND BIPOLAR DISORDER

Nouraan Sadiq, DO 1 ; Nauman Khalid, MD 2 1 VCOM-Louisiana; 2 Department of Internal Medicine at St. Francis 87 RARE COMPLICATION OF ATRIAL FIBRILLATION ABLATION: ATRIAL ESOPHAGEAL FISTULA

Context/Impact: In the general patient population chronic illnesses and psychiatric disorders often coexist and create complex challenges at times of diagnosis and management. The physical and mental burden of a chronic disease combined with psychological and social stressors can exacerbate pre-existing mental health conditions and even trigger new ones. Report of Case: This case report discusses a 43-year-old African American female, full time resident of a nursing home, with a history of bipolar disorder and sickle cell disease from which she is suffering from chronic complications including blindness secondary to bilateral retinal detachment in the last 2 years. The patient presented to a psychiatrist upon referral from their nursing home after exhibiting agitation, verbal aggression, unstable mood, and psychosis. Her case highlights the profound impact that chronic illness can have on mental health and shows the connection between the biological, psychological, and social factors contributing to her condition. Management requires a multidisciplinary approach utilizing professionals from family medicine, social

work, nursing, and pharmacy to address her psychiatric symptoms as well give due attention to the challenges of her chronic illnesses and disability. Comments/Conclusion: This case emphasizes the critical need for an integrated healthcare approach that bridges together medical and psychiatric disciplines and serves as a reminder that treating one aspect of health alone would be an injustice to holistic and well-rounded patient care. A lack of coordination between these disciplines can lead to disordered and even detrimental treatment where neither condition could be adequately addressed. Having collaborative care models can provide holistic approaches towards the patient’s needs and address the physiological, psychological, and even social considerations of the patient’s health. In the case of this patient, timely mental health intervention along with medical care for their sickle cell disease can potentially mitigate the onset of possibly severe psychiatric symptoms and help to improve quality of life. A PubMed search of case reports published in the last 10 years looking for sickle cell disease and psychosis yielded no results that included a

related cause of psychosis or a psychotic event in an adult reflective of our patient’s unique social and medical history. Greater awareness and research into the relationship that exists between chronic diseases and psychiatric conditions are essential to improve patient care and patient health outcomes.

Context: One of the most commonly used methods to treat drug-refractory atrial fibrillation which has been recently developed is radiofrequency catheter ablation that carries the risk of rare and grave complications comparable to other procedures. One of the most serious complications is the development of an atrial esophageal fistula as a result of iatrogenic esophageal ulceration that carries with it a high mortality rate. We report a case of an atrial esophageal fistula in a 55 year old male who initially presented to the emergency department (ER) with nonspecific symptoms of chills, fatigue, cough, and left arm dysesthesia. He had undergone radiofrequency ablation for drug refractory atrial fibrillation in the previous 3 weeks, and was initially discharged from the ER with the diagnostic impression of pneumonia. However, as soon as the patient was discharged, he went into cardiac arrest and became pulseless in the parking lot. He was successfully resuscitated and admitted afterwards, and subsequently underwent left and right heart catheterization that revealed no signs of obstructive coronary artery disease, while his echocardiogram showed features suggestive of Takotsubo cardiomyopathy. The next morning

the patient developed right sided weakness and became aphasic. Initial head computed tomography (CT) was negative, but follow up scan revealed signs indicative of an air embolism causing the stroke. Later that night the patient developed a ST elevated myocardial infarction (STEMI) and underwent left heart catheterization with percutaneous transluminal coronary angioplasty of the distal right coronary artery and intracoronary epinephrine to restore full flow. Patient then went for CT angiogram of the chest after developing petechiae on the chest post-left heart catheterization in the intensive care unit (ICU). However, he developed cardiac arrest during CT scan, but was successfully resuscitated. He was in poor neurological condition, and after discussion with the family, he was made DNR and only given comfort care. His family agreed to organ donation and he was terminally extubated in the OR. The primary reason for presenting this case is to highlight the importance of early diagnosis of atrial esophageal fistula with immediate surgical intervention to reduce morbidity and mortality.

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101 2025 Research Recognition Day