Louisiana Research Day Program Book 2025

Case Studies: Section 1

Case Studies: Section 1

Adedayo Olatunji, OMS-III VCOM-Louisiana 59 RECOGNIZING COVID-19 AS A PERSISTENT RISK FACTOR FOR ACUTE THROMBOEMBOLIC EVENTS IN MILD CASES OF INFECTION

Alyssa Breazeale, OMS-III 1 ; Mark Megaly, MD 2 ; Pamraj Sharma, MD 2 1 VCOM-Louisiana; 2 Department of Neurology, Saint Francis Medical Center 58 A RARE CASE OF PRES

Background: Posterior reversible encephalopathy syndrome (PRES) is a rare neurological phenomenon characterized by acute vasogenic edema involving the posterior circulation of the brain, often localizing to the occipital and temporal lobes. Affected patients typically present with altered sensorium, seizures, visual deficits, and characteristic features on neuroimaging. PRES has been associated with an increasing number of clinical etiologies but has a highest association with autoimmune disease, immunosuppressive therapy, eclampsia, renal disease, and malignancy. There are two main theories for the pathophysiology of PRES. The first theory, which bolsters the most support in this case, is the hypertension induced hyperperfusion theory. This theory states that the vasogenic edema seen in PRES results when systemic hypertension surpasses the autoregulatory range resulting in unmitigated hydrostatic pressure that is most pronounced in the posterior circulation where there is reduced adrengeneric perivascular fibrosis. However, this theory fails to account for the 30% of PRES patients who do not demonstrate overt hypertension at the time of diagnosis. The second theory posits

that PRES is a result of endothelial dysfunction secondary to inflammation, cytotoxic injury, or a combination of both at the level of the blood brain barrier. This theory is favored in the context of PRES in the absence of hypertension in patients with overwhelming inflammatory states such as sepsis and autoimmune disease. This syndrome typically resolves with an address of inciting factors and strict blood pressure management and rarely results in long term sequelae if prompt recognition and management is achieved. Here we present the case of a 27-year old female who initially presented with diffuse debilitating arthralgia and a vasculitic rash of the bilateral lower extremities. She was hospitalized while an autoimmune investigation was launched and showed marked improvement with Solu Medrol and Toradol therapy. Autoimmune panels demonstrated evidence of disease and the patient was referred to outpatient rheumatology where she was formally diagnosed with Systemic Lupus Erythematosus (SLE) complicated by Lupus Nephritis class IV. She was subsequently initiated on a treatment course of Mycophenolate and Prednisone. In the week following treatment initiation the patient again presented to the ED with seizure activity in

the context of notable hypertension. MRI of the brain as well as clinical picture were consistent with PRES. Due to the timing of onset coinciding with initiation of mycophenolate discontinuation of this medication was recommended. The patient showed marked improvement with discontinuation of immunotherapy and adequate blood pressure control. Follow up imaging at a 3 months interval revealed complete radiological resolution of PRES. This case study will seek to illuminate a novel origin of PRES secondary to mycophenolate usage. We propose that PRES in this clinical context may be the result of Mycophenolate’s off-target dysregulation of vascular adhesion molecules leading to a reduced response to endothelial damage sustained as a result of systemic hypertension. We aim to expand medical literature devoted to this topic and increase practitioner vigilance when managing patients on mycophenolate therapy.

Background: Acute thromboembolic events, including deep vein thrombosis, pulmonary embolism, and arterial thrombosis, are recognized complications of both active and resolved COVID-19 infections. This report presents the case of a 58-year-old male admitted for bilateral pulmonary embolisms two months after a mild COVID-19 infection and two weeks following a transatlantic flight from North America to the United Kingdom. The patient presented to the emergency department with symptoms of shortness of breath, congestion, cough, and left-sided chest pain. A computed tomography angiogram (CTA) revealed acute bilateral pulmonary emboli with an extensive clot burden. A SARS-CoV-2 PCR nasopharyngeal swab confirmed the patient was not COVID-19 positive at the time. Current evidence suggests that the risk of acute thromboembolism remains elevated for months following COVID-19 infection. This case emphasizes the need for heightened clinical vigilance, even in patients who experience mild COVID-19 infections, and underscores the importance of implementing preventative strategies to mitigate long-term thrombotic risks.

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2025 Research Recognition Day