Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Shailie Shah, OMS-III 1 ; Sabeen Wazir, OMS-III 1 ; Umama Zareen, MD 2 1 VCOM-Louisiana; 2 CHRISTUS St. Frances Cabrini Hospital; Alexandria, Louisiana 45 ESSENTIAL THROMBOCYTHEMIA: AN UNFORTUNATE SILENT RISK FACTOR IN MYOCARDIAL INFARCTION AND PNEUMONIA PATIENT

Christine Joy Palma, BS 1 ; Sabeen Wazir, BS 1 ; Sahana Padumane, MS 1 ; Stephen DiGiuseppe PhD 1 ; Michael J. Marzullo MD 1 1 VCOM-Louisiana 46 TOPICAL KETOCONAZOLE: A SIMPLE TREATMENT FOR GRANULOMA GLUTEALE INFANTUM

Context/Impact: Essential thrombocythemia (ET) is a rare myeloproliferative neoplasm associated with an increased risk of thrombotic events, particularly in older patients and those with cardiovascular comorbidities. This case highlights a how complex fatal cascade, in which atypical pneumonia with bacterial and fungal elements resulted in a prothrombotic milieu of ET culminated into a non–ST-elevation myocardial infarction (NSTEMI), an association that remains poorly represented in current literature. Case Report: A 58-year-old male with a history of essential thrombocythemia, peripheral artery disease, and chronic obstructive pulmonary disease presented with chest pain and shortness of breath to the emergency room. Imaging revealed a right upper-lobe cavitary lesion consistent with a previously diagnosed aspergilloma, and he was initially treated for pneumonia with antifungal and antibiotic therapy. Laboratory values at this time revealed a platelet (PLT) count 750,000. Despite elevated PLT counts, the patient continued his home-regimen of aspirin and clopidogrel with no changes. Following

outpatient bronchoscopy demonstrating mixed aspergillosis and gram-negative bacteria, the patient returned to the emergency room due to loss of consciousness, with familial reports of continuous shortness of breath throughout the day. The patient’s bloodwork revealed a platelet count of 800,000 (normal range 150,000 - 450,000), elevated lactate, and elevated troponin I. Electrocardiogram (EKG) results were consistent with NSTEMI. Ultimately our patient was diagnosed with both NSTEMI secondary to septic shock. Despite aggressive antimicrobial therapy, vasopressor support, and intensive care management, his course rapidly progressed to cardiac arrest and death. Conclusion: A PubMed literature review, using the terms Essential Thrombocythemia AND NSTEMI, reveal 3 case reports of this incidence, indicating how little is known about ET as a risk factor for NSTEMI. Despite current guidelines for chronic management ET, classifying our patient as high-risk, our patient remained well-controlled on anti-platelet therapy without cytotoxic therapy. However, management of ET in acutely ill patients has no current recommendations, reflecting a gap in clinical management.

Furthermore, this case raises the question of whether systemic infection and sepsis should prompt temporary intensification of therapy or closer cardiovascular surveillance in ET patients, an area not directly addressed in existing recommendations.

Context: Granuloma gluteale infantum (GGI) is an extremely rare diaper rash with an estimated number of reported cases to be around 30. This condition is characterized by clustered erythematous and violaceous papules that resemble pyogenic granulomas within the gluteal and perianal region. Due to its rarity, a standard treatment for this condition has not been established. In this report, we describe the case of a 2-month-old patient with GGI that resolved with the use of topical antifungals and time. Report of Case: A 2-month-old male patient presents to the clinic with a recalcitrant rash on his intragluteal region that has been unresolved over the past 1.5 months. Previous treatments included 2% mupirocin ointment, Fluconazole suspension, 2% ketoconazole cream, 75 mg Clindamycin IM, and 0.05% Desonide cream. Upon physical exam, the patient is noted to have well-demarcated, hemorrhagic papular clusters containing a blue-ish base on the inner buttocks. After consulting two pediatric dermatologists, the patient was ultimately diagnosed with GGI and successfully treated with 1% ketoconazole cream.

Conclusion: The term “Granuloma Gluteale Infantum” yields 32 PubMed search results, with more reviews on GGI published than cases. Upon further inspection, only one case report has reported successful resolution of this condition with the usage of antifungal creams. Here, we report a second case of resolved GGI with the use of ketoconazole. We hope that this case sheds light on the potential treatment for this condition as well as the symptoms and appearance of this rare entity.

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2026 Research Recognition Day