Louisiana Research Day Program Book 2025

Case Studies: Section 1

Case Studies: Section 1

Brady Levron, OMS-III; Brooke Grieme, OMS-III; Moneeb Mustafa, MD 1 Department of Internal Medicine, Rapides Regional Medical Center, Alexandria, LA 63 ELEVATED TROPONIN IN OPIOID OVERDOSE: DIAGNOSTIC CHALLENGES IN DIFFERENTIATING MYOCARDIAL INJURY FROM NON-ISCHEMIC CAUSES

Briana Krutsinger, BS; Savannah Newell, PhD 1 VCOM-Louisiana; 2 Department of Internal Medicine, St. Francis, Monroe, LA 62 PELVIC INFECTION TO SYSTEMIC CRISIS: A CASE OF SEPTIC SHOCK DUE TO PELVIC INFLAMMATORY DISEASE

Context/Impact: This case highlights the significance of early diagnosis, management, and prevention of severe pelvic inflammatory disease (PID). It illustrates the multidisciplinary approach required to manage septic shock secondary to PID and provides insight for clinicians about the presentation and differential diagnosis of critically ill patients presenting with abdominal pain and systemic infection. PID is a spectrum of disorders of the upper female genital tract including tubo-ovarian abscess, pelvic peritonitis, and salpingitis. 1 Over 50% of women diagnosed with PID have a positive test for either N. gonorrhoeae or C. trachomatis. 1 Report of Case: 28-year-old female presented with severe abdominal pain worsening over the previous two days. The patient was tachycardic, hypotensive, and remained hemodynamically unstable despite IV fluid resuscitation, necessitating vasopressors, and ICU admission. Abdominal CT imaging revealed an inflammatory process in the pelvis. Transvaginal ultrasound illustrated a left ovarian 2.3 cm mass consistent with a complex cyst or corpus luteum. Additional findings included fluid surrounding the left ovary, and dilated bowel loops or what could be dilated

fallopian tubes in the adnexal region. Laboratory testing showed leukocytosis with neutrophil predominance and left shift. PCR confirmed N. gonorrhoeae. Initial treatment included IV Cefepime, doxycycline, and metronidazole to treat possible urinary tract infection, PID, and other intrabdominal infections. Over the next 24 hours patient continued to decline, and white blood cell count continued to increase. Obstetrician gynecologist and general surgery were called to reconsult and decided to perform exploratory laparotomy which revealed severe PID with left tubo-ovarian abscess, right hydrosalpinx, and upper abdominal Fitz Hugh Curtis syndrome. OBGYN performed an operative laparoscopy with left salpingo oophorectomy and right salpingectomy. Patient tolerated being weaned off vasopressors and WBC count continued to trend down. Patient had almost complete relief of abdominal pain immediately post-operatively. Conclusions: This case highlights the severe complication of septic shock in inadequately managed pelvic inflammatory disease. PID in the United States impacts an estimated 1 million women per year.1 The existing literature

fails to describe the epidemiologic impact of septic shock secondary to PID. Three published case reports of gonococcal septic shock were identified. Two of the cases described patients who were immune compromised.2 In contrast, this case illustrates aggressive management with surgical intervention in an immune-competent patient with a favorable outcome. This report illustrates the importance of early recognition of systemic infection, timely use of broad-spectrum antibiotics, surgical intervention, and the need for multidisciplinary care to improve patient outcomes. It emphasizes the need for preventive measures with STI screening, patient education, and follow-up care to aid in reducing the risk of recurrence and long-term complications like infertility and chronic pelvic pain.

Background: Opioid overdose remains a significant public health concern, contributing to rising morbidity and mortality despite advancements in addressing opioid abuse. While the immediate risks of respiratory depression and death are well known, the relationship between opioid overdose and elevated cardiac biomarkers, such as troponin, is more difficult to differentiate. Elevated troponin is typically associated with myocardial infarction, yet its presence in non-acute coronary syndrome settings, including drug overdose, raises diagnostic challenges. This case report presents a 53-year-old male with a history of opioid abuse, who presented with opioid overdose and elevated troponin levels, raising concerns for myocardial injury. Despite the troponin elevation, the patient’s clinical course suggested a non-ischemic cause, related to respiratory failure, hypoxia, and the physiological stress of resuscitation. The case emphasizes the need to differentiate between ischemic and non-ischemic causes of elevated troponin in patients with opioid toxicity, which can prevent unnecessary interventions and improve patient outcomes. By analyzing this case within the framework of current clinical guidelines, we

aim to explore the potential mechanisms of opioid-induced myocardial injury and provide a structured approach for evaluating troponin elevations in non-ACS contexts. This case underscores the importance of interpreting cardiac biomarkers within the appropriate clinical setting.

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2025 Research Recognition Day