Louisiana Via Research Day Book 2026

Case Studies: Section 2

Case Studies: Section 2

Binod Mehta MD 1 ; Shiv K. Jha, MD 2 ; Monika Pandit, MD 3 , Pamraj Sharma, MD 1 ; Coy Gammage, MD 4 1 St. Francis Medical Center; ²Montefiore Medical Center, Bronx, New York; ³Jacobi Medical Center / NYC Health + Hospitals–North Central Bronx; 4 St. Francis Oncology & Hematology Clinic 94 A RARE CASE OF RECURRENT ANAPLASTIC OLIGODENDROGLIOMA MANAGED WITH ULIXERTINIB, AN INVESTIGATIONAL ERK1/2 INHIBITOR

Muhammad Mehwar Anjum; Harikrishna Bandla; Deekshitha Manney; Tanya Nazar Department of Internal Medicine, IM Residency, Saint Francis Medical Center, Monroe, Louisiana 95 FRACTURE FOR A PULSE: CHANCE-TYPE THORACIC FRACTURE FOLLOWING MECHANICAL CPR WITH LUCAS DEVICE

Introduction: Anaplastic oligodendroglioma is a rare WHO Grade III glioma, with an incidence of fewer than two cases per million annually in the United States. Defined by IDH mutation and 1p/19q codeletion, it typically affects middle aged adults and carries a high recurrence rate despite standard multimodal therapy. Once resistance develops to alkylating agents such as temozolomide, effective treatment options are limited. Here, we present a recurrent case of anaplastic oligodendroglioma managed with the investigational ERK1/2 inhibitor Ulixertinib (BVD 523), highlighting the potential role of MAPK pathway-directed therapy in refractory glioma. Report of Case: A 46-year-old male was diagnosed with an IDH1-mutant, 1p/19q codeleted anaplastic oligodendroglioma in 2019. At that time, he underwent right temporal craniotomy with gross-total resection, followed by adjuvant radiation and temozolomide. In 2023, he had recurrence of this tumor, now requiring gamma-knife radiosurgery, followed by an additional course of temozolomide. The patient did well initially but developed worsening headaches, dizziness and visual changes. Evaluation with repeat MRI brain revealed

a right temporal lobe enhancing mass with surrounding vasogenic edema and mass effect. He again underwent surgical maximal resection, pathology of which confirmed recurrent anaplastic oligodendroglioma. Although he was placed on modified PC chemotherapy with procarbazine and lomustine, he was unable to tolerate treatment due to thrombocytopenia and radiologic progression. Considering limited standard treatment options, he was enrolled in the window-of-opportunity clinical trial NCT05804227 evaluating Ulixertinib, an ERK1/2 inhibitor targeting the MAPK pathway. His treatment was complicated by development of a maculopapular rash which was managed conservatively. After an initial period of radiographic stability, disease progression again occurred and patient was transitioned to bevacizumab with temozolomide rechallenge. On this treatment regimen, radiographic stability was achieved over the following months. Today, he remains clinically stable under surveillance. Conclusion: This case illustrates the therapeutic challenges of recurrent anaplastic oligodendroglioma and the importance of exploring molecularly targeted approaches when

conventional options fail. Ulixertinib is a novel ERK pathway inhibitor under investigation for CIC- or MAPK-altered gliomas. Although clinical benefit was limited, this case underscores the feasibility of precision-based trial enrollment and the need for continued research into targeted therapies for rare CNS tumors.

Context: Chest wall injuries such as rib and sternal fractures are frequently observed after cardiopulmonary resuscitation (CPR), but vertebral fractures, especially those of the Chance-type pattern, are exceedingly rare and likely underrecognized. Report of Case: An 80-year-old man with atrial fibrillation (rhythm device), coronary artery disease, prior cervical fusion, and a remote cervical fracture was found pulseless outside his home after more than 12 hours. Emergency Medical Services initiated mechanical CPR using the Lund University Cardiopulmonary Assist System (LUCAS) for approximately 15 minutes, achieving return of spontaneous circulation. He was intubated and transported to the emergency department. On arrival, he had extensive chest wall bruising, lacerations, and facial petechiae. Head CT was unremarkable, but he remained minimally responsive. Subsequent CT of the abdomen incidentally revealed a Chance-type fracture through the mid-to-inferior T11 vertebral body with 2 cm of distraction, extending through the posterior elements and facet joints; consistent with a flexion-distraction injury. Bridging

osteophytes and diffuse degenerative changes indicated underlying spondyloarthropathy, contributing to spinal rigidity. Rhythm device interrogation showed no ventricular arrhythmia prior to the arrest. Given poor neurologic recovery and severe thoracic trauma, care was transitioned to comfort measures after palliative consultation. Conclusion: Vertebral fractures after CPR are exceedingly uncommon, particularly those of the Chance-type configuration. Only a few similar cases have been reported, nearly all in elderly patients with rigid spines or prior spinal fusion; highlighting increased susceptibility in this population. Mechanical CPR devices, though lifesaving and comparable to manual CPR in survival outcomes, deliver uniform, high-force compressions that can predispose patients to severe structural injuries. As the use of automated compression devices expands in both prehospital and inpatient settings, awareness of these rare complications is critical. Persistent irresponsiveness or marked chest wall trauma after successful resuscitation should prompt consideration of spinal injury. Early detection not only guides management

but also informs family counseling regarding prognosis and potential complications.

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2026 Research Recognition Day