Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Douglas Le, BS, MS 1 ; Kerry Thibodeaux, MD, FACS, CWS,P FACCWS, FAPWCA 2 1 VCOM-Louisiana; 2 Opelousas General Hospital 33 SUCCESSFUL TOPICAL MANAGEMENT OF A LOWER LEFT EXTREMITY CARBUNCLE USING HYPOCHLOROUS ACID: A CASE REPORT ON CHRONIC WOUND CARE AND ITS APPLICATIONS IN RURAL HEALTH

Anthony Elliott, OMS-III 1 ; Moneeb Mustafa, MD 2 1 VCOM-Louisiana; 2 Department of Internal Medicine, CHRISTUS St. Francis Cabrini Hospital, Alexandria, Louisiana 34 CHRONIC WHITE MATTER CHANGES (LEUKOARAIOSIS) PRESENTING WITH EXPRESSIVE APHASIA

Context: Chronic wounds can be indicative of underlying comorbidities such as immunodeficiency, bacterial resistance, or vascular impairments that ultimately prevent proper wound healing. A topical hypochlorous acid therapy has been shown to facilitate healing in a chronic carbuncle that was refractory to standard antibiotic therapy. Report of Case: A 34-year-old male presented with a chronic carbuncle on his lower left leg. The lesion contained numerous pustules, crusted skin, bloody exudate, and maintained a purplish discoloration surrounded by an erythematous base. The patient was initially treated with antibiotics but was referred to the wound care clinic due to delayed healing. Excisional debridement of the pustules and topical vancomycin-soaked gauze were initially used to dress the lesion. One week later, there was significant improvement and cultures were negative, but biopsy revealed multiple microabscesses throughout the wound. Topical hypochlorous acid (HOCl) therapy with cover dressings was initiated. At one week follow up, the lesion demonstrated remarkable improvement with complete resolution of

pustules, minimal erythema, and minimal tenderness. Application of HOCl twice daily was continued. At one month follow-up, the patient demonstrated a near complete resolution of the lesion. There was no longer any evidence of infection around the lesion, and the patient no longer reported any pain. Triamcinolone cream was added to his treatment protocol to reduce inflammation and itchiness. At two months follow-up, the patient presented no signs of an active infection of the lesion. The lesion demonstrated a markedly improved appearance with no new areas of drainage. At three months follow-up, the patient’s wound has essentially healed. The tissue surrounding and underlying the lesion was intact with only signs of erythema remaining. Concurrently, a new pustular formation secondary to an insect bite presented distal to the original lesion. The patient was instructed to continue his daily HOCl regimen and follow-up as needed for maintenance of his original carbuncle and management of his newly formed lesion. Conclusion: The case of a 34-year-old male patient with a chronic lower left extremity carbuncle provides an unusual case. Although

carbuncles can develop anywhere hair follicles are present, they are more likely to form in areas exposed to increased sweat and friction such as the neck, back, and groin. This patient’s condition was further complicated by his history of cigarette smoking, which has been shown to significantly delay wound healing. The use of a topical antimicrobial agent to sterilize the wound was favored over systemic oral antibiotics because the patient lacked constitutional symptoms such as fever, lymphadenopathy, and sepsis. In the setting of a chronic wound complicated by increased bacterial burden and a history of chronic cigarette smoking, a topical hypochlorous acid spray demonstrated the ability to clear the wound of active infection and facilitate successful healing. This therapy modality can be especially beneficial in clinics that mainly serve rural populations, as it can be easily administered in an outpatient setting and eliminate the need for patients to travel long distances to receive care.

Context: Age related white matter hyperintensities (Leukoaraiosis or LA) is a common finding in aging patients. LA most likely results from chronic ischemia and is associated with vascular risk factors, and it in turn increases the risk of stroke and dementia. However, only a few reports have linked LA with focal neurological deficits. Report of Case: This case study details a 41-year-old male with primary hyperaldosteronism who presented with a lack of ability to initiate words, with preserved comprehension, and with hypokalemia with a potassium level of 3.5 mmol/L. No other significant neurological findings were present. A head computed tomography scan revealed no acute changes; however, diffusion-weighted MRI revealed bright hyperintensities in the patient’s white matter tracts, pointing to leukoaraiosis as the most likely etiology. The patient was admitted and managed with atorvastatin, aspirin, and potassium replacement therapy. He experienced marginal improvement during inpatient follow-up. The potassium level initially decreased, and then rose again stabilizing at 3.5 mmol/L. Upon discharge, the patient was

referred to follow up with speech therapy and to a tertiary care facility.

In this case study, therefore, it is reasonable to conclude that the most likely etiology of the patient’s aphasia would be leukoaraiosis. This is an uncommon presentation that would need to be differentiated from a stroke with diffusion weighted MRI.

Conclusion: There are a few reports of white matter disease presenting as isolated aphasia that support attributing this patient’s presentation to leukoaraiosis. For example, a 2011 study of 48 individuals identified seven patients with nonfluent primary progressive aphasia, and demonstrated on MRI diffusion weighted imaging that the greatest white matter changes were located in the dorsal pathways. A 2014 study of 46 individuals showed that left white matter pathways connecting the speech production network are selectively damaged in non-fluent primary progressive aphasia and emphasizes the role of diffusion imaging in the differential diagnosis of neurodegenerative diseases. A 1989 case report demonstrated a patient with Creutzfeldt-Jacob disease, whose first presentation was isolated aphasia. A 2021 case study showed a unique presentation of isolated aphasia in a patient with multiple sclerosis. Evidently, there is some literature precedent for white matter changes, both acute and chronic, as an etiology for isolated neurologic deficits such as expressive aphasia.

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2026 Research Recognition Day