Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Patrick Karmo, OMS-I; Reagan Lee, OMS-I; Caroline Vanhook, OMS-I; Kirtan Patel, OMS-I; Agnes Wilson, OMS-I; Jenna Dittmar, PhD VCOM-Louisiana 71 TEACHING THROUGH ABSENCE: AN EXAMPLE OF SYMBRACHYDACTYLY IN A 69-YEAR OLD MALE

Madeline Keen, OMS-III 1 ; Nisheem Pokharel, MD 2 1 VCOM-Louisiana; 2 Department of Internal Medicine, St. Francis Medical Center, Monroe, Louisiana 72 BEYOND SINUSITIS: AN ATYPICAL PRESENTATION OF GRANULOMATOSIS WITH POLYANGIITIS

Context/Impact: Symbrachydactyly is a rare, non-hereditary limb anomaly that presents as the absence or underdevelopment of one or more fingers, typically affecting one hand. Most cases currently described in literature are those identified at birth and describe the pediatric surgical and non-surgical management. However, gross anatomical documentation of those left untreated in adults is limited. This lack of literature represents a gap in both clinical, research, and educational domains surrounding this deformity. Report of Case: We present a case of a congenital hand anomaly in a 69-year-old male willed body donor whose cause of death was reported as a brain hemorrhage. We observed that his left hand had a full first digit, lack of digits two through four, and a deformed fifth digit; while his right hand was anatomically typical. Dissection revealed no significant anatomical differences between the left and right upper limbs. Since there was no scarring on the left hand, or evidence of past surgical procedures, we concluded that he had a rare unilateral congenital disorder of Symbrachydactyly affecting the left hand.

Conclusion: Our case demonstrates the importance of recognizing and documenting congenital limb anomalies not only for education but to better inform physicians, therapists and prosthetists in treatment, rehabilitation, and lifelong management of these conditions. This report may offer additional insight into the conversation of musculature development in embryology, and how this developmental process may proceed independently rather than entirely alongside skeletal formation. This case reinforces the role of gross anatomy in the advancements of treatment, as well as further aiding to bridge the gap between embryology, clinical management, and patient-centered care.

Context: Granulomatosis with polyangiitis (GPA) is a rare vasculitic disorder classically defined by a triad of systemic necrotizing vasculitis, necrotizing inflammation of the respiratory tract, and necrotizing glomerulonephritis. It affects approximately 4–10 individuals per million and carries an untreated mortality approaching 80%. This report describes a case of GPA initially manifesting as refractory sinusitis. Report of Case: A 69-year-old Caucasian woman with chronic sinusitis, conductive hearing loss, and recent tympanostomy tube placement for chronic otitis media had multiple recent visits to her primary care provider and the emergency department (ED) for nasal congestion and pansinusitis. Exams consistently showed mucosal edema, rhinorrhea, maxillary tenderness, and oropharyngeal erythema. Labs including CBC and CMP, were unremarkable, and testing for influenza, COVID-19, and streptococcal pharyngitis were negative. She was treated with antibiotics and steroids, but continued to have fevers, sore throat, and fatigue despite additional antibiotic courses. She returned to the ED with her usual symptoms, but now accompanied by shortness of breath,

with an oxygen saturation of 90%. Labs revealed leukocytosis with neutrophilic predominance. CT imaging showed diffuse sinus disease, a mild right-sided pleural effusion, and subsegmental atelectasis or scarring in the left lower lobe. Further workup revealed markedly elevated inflammatory markers (CRP 158.8 mg/L) and acute kidney injury, with a creatinine of 2.96 mg/dL from a baseline of 0.89 mg/dL and a BUN of 52 mg/dL. Chest radiography demonstrated new bilateral alveolar infiltrates. She was treated for presumed pneumonia with acute hypoxic respiratory failure and prerenal acute kidney injury using vancomycin and piperacillin-tazobactam, intravenous corticosteroids, bronchodilators, and IV fluids. On hospital day five, she developed new lower extremity edema with worsening renal function. Serologic testing revealed elevated rheumatoid factor, positive c-ANCA, and elevated anti– proteinase 3 antibodies. CT-guided renal biopsy demonstrated crescentic glomerulonephritis, confirming GPA with renal involvement. She was started on rituximab and oral corticosteroids, along with trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia prophylaxis.

Conclusion: Early recognition and treatment of GPA are critical, as delayed diagnosis is associated with significant morbidity and mortality. Despite the availability of c-ANCA and anti-PR3 testing, the disease’s varied and nonspecific presentations often delay diagnosis.

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2026 Research Recognition Day