Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Nicholas Lam, OMS-III 1 ; Sydney Dean, OMS-III 1 ; Sarah Sharkey, MD 2 1 VCOM-Louisiana; 2 Opelousas General Hospital, Department of Pulmonary and Critical Care Medicine 73 IDIOPATHIC INFLAMMATORY MYOPATHY IN THE SETTING OF EMPHYSEMA, POLYMICROBIAL PNEUMONIA, AND REFRACTORY HYPOXIA

Emma Barham, BS, OMS-IV 1,2 ; Maham Khan, MS, BS, OMS-IV 1,2 1 VCOM-Louisiana; 2 St. Francis Medical Center, Monroe, Louisiana 74 INCIDENTAL DISCOVERY OF A MORGAGNI HERNIA

Context: While interstitial lung disease (ILD) is present in over 40% of polymyositis and dermatomyositis cases, ILD presents as the initial finding in as low as 7.2% of cases. This complex case demonstrates the importance of a broad differential diagnosis, considerations of autoimmune myositis when ILD is the initial manifestation, and the utilization of CellCept monotherapy. Report of Case: A 63 year-old female with COPD presented to the emergency department with the chief complaint of worsening dyspnea. Initial SPO2 was in the 80’s on her at-home baseline 2L O2 and she was increased to 5L. She reported recent pneumonia treatment with Levaquin and tobramycin. Chest x-ray and CT scan ordered by the ED showed emphysema, pulmonary fibrosis, and ground glass opacities consistent with pneumonia. The patient was admitted to the PCU with the diagnoses of pneumonia and acute on chronic hypoxic respiratory failure. She was started on cefepime and vancomycin, steroids, and bronchodilators. On admission day 3 physical/ occupational therapy were initiated and she became profoundly hypoxic with exertion with

SPO2 in the 70’s. She was placed on BiPAP and pulmonology was consulted. By admission day 7, the patient alternated between requiring BiPAP and high-flow nasal cannula. All weaning attempts had failed and she continued to become acutely hypoxic with minimal exertion despite optimization of respiratory therapy. Multiple repeat chest x-rays throughout her stay revealed unchanged and worsening opacities. The pulmonology team requested her outside pulmonology records and ordered an autoimmune panel. Outpatient pulmonology records were reviewed and revealed recent respiratory culture positive for candida. Voriconazole was added to the antimicrobial regimen for fungal coverage. On admission day 9 the autoimmune panel results were found to be consistent with myositis (elevated SRP AB and MI2ß AB). After thorough discussion with the patient regarding the benefits and risks of immunosuppression, CellCept and IVIg were initiated. As the patient gradually improved, she was weaned back to her baseline of 2L O2 and was deemed stable enough for discharge to a swing bed on day 21 with outpatient pulmonology follow-up.

Conclusion: Currently there is no set criteria for myositis screening when ILD is the initial manifestation; rather, it is considered when other etiologies are ruled out or when treatment fails to yield improvement. Ideally in cases with severe respiratory findings a combination of CellCept and Rituxan is utilized. The choice to use CellCept monotherapy over the preferred combination regimen was due to both insurance coverage and risk of further immunosuppression given her concurrent pneumonia. Despite this, the patient’s respiratory function still returned to her baseline.

Context: Morgagni hernias are rare congenital anterior diaphragmatic defects that often remain asymptomatic until adulthood, leading to delayed or incidental diagnosis. This case underscores the diagnostic challenge of Morgagni hernias in adults and highlights minimally invasive surgical repair as an effective treatment approach. Report of Case: A 51-year-old female with a history of diabetes mellitus and migraines presented with subjective dyspnea, chest pain, and constipation. Physical examination was unremarkable. Chest computed tomography revealed a large right-sided anterior diaphragmatic defect consistent with a Morgagni hernia, containing incarcerated omentum and transverse colon. Imaging also incidentally identified a large gallstone within the gallbladder. The patient underwent robot-assisted laparoscopic repair of the diaphragmatic hernia. Intraoperatively, a significant amount of omentum and transverse colon were reduced with confirmed viability and no injury to surrounding structures. The diaphragmatic defect measured approximately 10 × 6 cm and was repaired using nonanatomic ProGrip mesh

with transverse closure utilizing 0 V-Loc suture. The patient tolerated the procedure well without complications. Conclusion: Morgagni hernias account for a small percentage of congenital diaphragmatic hernias and are infrequently diagnosed in adults due to nonspecific or absent symptoms. Compared to cases described in the literature, this patient similarly presented with vague cardiopulmonary and gastrointestinal complaints, emphasizing the importance of imaging in diagnosis. A literature review was conducted using PubMed and Google Scholar with search terms including “Morgagni hernia,” “adult diaphragmatic hernia,” and “laparoscopic Morgagni hernia repair.” Consistent with reported cases, minimally invasive surgical repair was associated with favorable outcomes. This case supports robot-assisted laparoscopic repair as a safe and effective management strategy for adult Morgagni hernias.

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2026 Research Recognition Day