Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Sophie Qui, OMS-III 1 ; Olufemi Ogundeji, MD 2 1 VCOM-Louisiana; 2 Chemical Dependency Unit, Brentwood Hospital, Shreveport, Louisiana 32 SEVERE ALCOHOL USE DISORDER IN A DEAF, MUTE, AND ILLITERATE PATIENT: A CASE REPORT AND REVIEW OF DISABILITY-LINKED SUBSTANCE USE VULNERABILITIES

Sahana Ravi Padumane, OMS-III 1 ; Eric Amy, MD 2 ; Tricia Lowrey, MD 3 1 VCOM-Louisiana; 2 Opelousas General Surgical Associates; 3 ReliaPath 31 NON-SECRETORY GALLBLADDER PARAGANGLIOMA: AN INCIDENTAL FINDING ON LAPAROSCOPIC CHOLECYSTECTOMY

Context/Impact: A 35 year-old female patient presenting with RUQ pain and gallstones on imaging underwent a laparoscopic cholecystectomy with an incidental finding of a 0.5 mm paraganglioma tumor contained within the gallbladder wall. This is an exceedingly rare diagnosis, with only 26 cases currently published in the English medical literature. Report of Case: The patient reported having experienced several months of right upper quadrant abdominal pain. She had an ultrasound of the gallbladder done in July 2025, which showed mild gallbladder wall thickening, the presence of stones within the gallbladder lumen, no pericholecystic fluid, positive sonographic Murphy’s sign, and no obstruction of the bile duct. This prompted a referral to General Surgery for an elective laparoscopic cholecystectomy. On physical exam she had non-icteric sclera, with a nondistended abdomen and positive bowel sounds. The surgery was completed without complication. The removed gallbladder was sent to Pathology where it was sectioned and examined under the microscope. Histologic assessment found amphophilic polygonal cells with round nuclei arranged in a nesting pattern.

The cells were negative for Pancytokeratin but positive for Chromogranin, Synaptophysin, GATA-3, and S100. There were no mitotic figures present and Ki67 was low. The lesion was 0.5 mm and confined to the gallbladder wall with negative margins. These findings were noted by the pathologist to be consistent with Paraganglioma, a rare neuroendocrine tumor. Paragangliomas have the potential to be of a benign or a malignant nature1. Since the patient did not exhibit any symptoms consistent with a secretory Paraganglioma such as hypertensive episodes, the clinical suspicion for a secretory variant of the paraganglioma was assessed to be low. The patient completed a contrast CT scan of the Abdomen and Pelvis to assess for additional tumors approximately one month post-operation. The CT scan showed no remarkable findings, so the patient will continue regular follow-up with her PCP. Conclusion: A Paraganglioma finding in the gallbladder is an unusual finding due to its rarity. Similar to most GP cases previously reported on in the literature, it does not appear that the tumor was producing any hormones (Table 1). The gallbladder is innervated by

sympathetic nerves through the celiac plexus and parasympathetic nerves through the hepatic branch of the right vagus nerve2. Thus far, there have been no reported GP that has been of the secretory variant3-11. There have been reports on hemorrhagic GPs that lead to minor complications during removal5, however, our case was a completely incidental finding with no complications or gross abnormalities noted during surgery. There are no definitive guidelines on the management of Gallbladder Paraganglioma owing to the limited number of cases of this condition. Similar to most other cases of GP found in the literature, this case of GP was asymptomatic and non-secretory (Table 1). Characteristics found on staining were similar to other cases as well, with the GP staining positive for Chromogranin, Synaptophysin, and sustentacular cells staining for S100 (Table 1). Much is still unknown about Paraganglioma tumors of the Gallbladder. It is our hope that further contributions to this growing body of literature will elucidate unknown aspects of this condition and eventually lead to the establishment of clear treatment guidelines.

Background: Alcohol use disorder (AUD) in individuals with communication and literacy disabilities is poorly recognized and rarely described in the literature. Standard diagnostic and withdrawal management tools are not adapted for deaf, mute, and illiterate patients, creating gaps in equitable care. Case Presentation: A 64-year-old congenitally deaf, mute, and functionally illiterate man presented for protective custody alcohol detoxification after decades of consuming 12-30 beers daily. Bereavement and loss of his primary caregiver triggered escalation of use. CIWA scoring was not feasible due to communication barriers. Management included a lorazepam taper, naltrexone initiation, mirtazapine for mood symptoms, and osteopathic manipulative treatment for somatic complaints. Interpreter facilitated therapy and family involvement were central to stabilization. Conclusions: This case highlights the need for culturally and linguistically adapted withdrawal tools, early interpreter involvement, and disability-informed addiction treatment. To our knowledge, this is among the first reports

describing detoxification of a deaf, mute, and illiterate patient with severe AUD, underscoring the urgency of inclusive clinical protocols. Keywords: Alcohol Use Disorder; Deafness; Disability; Communication Barriers; Substance Use Disorder; Health Equity

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2026 Research Recognition Day