Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Brooke Grieme, OMS-IV 1 ; Megan Rachal, OMS-III 1 ; Brady Levron, OMS-IV 1 ; Muhammad Asad Janjua, MD 2 1 VCOM-Louisiana; 2 Division of Pulmonary and Critical Care at Rapides Regional Medical Center, Alexandria, Louisiana 77 REFRACTORY STATUS EPILEPTICUS TREATED WITH LACOSAMIDE AND CARBAMAZEPINE COMPLICATED BY COMPLETE HEART BLOCK AND CARDIAC ARREST

Danny Lee, MD¹; Gaity Wahab, MS-3²; Aymen Arain, OMS-II³; Maryam Babar, OMS-II³ 1 Department of Internal Medicine, University of California San Francisco Stanyan Hospital; 2 Ross University School of Medicine, Barbados; 3 VCOM-Louisiana 78 DERMATOLOGIC PROPHYLAXIS WITH THE COCOON PROTOCOL DURING EGFR-TARGETED THERAPY TRANSITION IN A PATIENT WITH METASTATIC EGFR-MUTANT NON–SMALL CELL LUNG CANCER

Context: Lacosamide and carbamazepine are antiepileptic drugs (AEDs) that act on voltage gated sodium channels and are widely used in the management of focal seizures and status epilepticus. Although each agent has been rarely associated with atrioventricular (AV) conduction abnormalities, severe bradyarrhythmias and complete heart block are uncommon, serious adverse events and cardiac conduction delays leading to cardiac arrest have been noted. Report of Case: This case report follows a 77-year-old female with a past medical history of recent subdural hematoma, hypertension, and hyperthyroidism who was admitted to the intensive care unit (ICU) following a fall and subsequently developed refractory focal status epilepticus. She was then started on a loading dose of lacosamide followed by carbamazepine for refractory focal seizures. Three days after induction with multiple antiepileptic drugs (AEDs) she developed sudden profound bradycardia progressing to asystole requiring multiple rounds of cardiopulmonary resuscitation (CPR) and vasopressor support for hemodynamic

associated with third-degree AV block. After a cardiology consultation, it was decided to discontinue the AEDs and insert a temporary pacemaker followed by a permanent dual chamber pacemaker placement. Her seizures were subsequently controlled with valproic acid alone without any further cardiac events. Upon review of her case, there was suspicion that the combination of carbamazepine and lacosamide may have contributed to the episodes of cardiac arrest. Conclusion: This case highlights the potentially life-threatening effects of lacosamide in combination with carbamazepine, showcasing the potential adverse effects of using multiple voltage gated sodium channel blockers in tandem to control refractory seizures. Clinicians should be made aware of the rare but serious conduction delays leading to cardiac arrest and consider continuous cardiac monitoring especially in elderly patients with pre-existing heart conditions.

Context: Cutaneous toxicities are among the most frequent adverse effects of epidermal growth factor receptor (EGFR) inhibitors and can significantly affect quality of life and treatment adherence. Patients undergoing transitions between EGFR-targeted therapies are at particularly high risk for dermatologic complications. This case highlights the role of early, preemptive dermatologic management to mitigate anticipated EGFR-related skin toxicity and support continuity of targeted oncologic therapy. Report of Case: A 64-year-old woman with metastatic EGFR-mutant non–small cell lung cancer was diagnosed in 2013 and treated sequentially with erlotinib, afatinib, and later osimertinib following identification of an EGFR T790M resistance mutation. In 2025, she presented with gait instability and cognitive decline. She was found to have obstructive hydrocephalus secondary to brain metastasis, requiring neurosurgical intervention with endoscopic third ventriculostomy and ventriculoperitoneal shunt placement. Following recovery, she resumed osimertinib therapy and developed diffuse xerosis with ash-like gray

discoloration consistent with early epidermal barrier dysfunction. In anticipation of transition to amivantamab–lazertinib therapy and given her elevated risk for EGFR inhibitor–associated cutaneous toxicity, prophylactic dermatologic management using the COCOON protocol was initiated. This included oral doxycycline, topical clindamycin, chlorhexidine washes, and ceramide-based moisturizers. Over the subsequent weeks, xerosis improved, and the patient did not progress to more severe dermatologic toxicities, allowing uninterrupted continuation of systemic therapy. Conclusion: This case demonstrates the value of anticipatory, risk-based dermatologic prophylaxis during transitions in EGFR-targeted therapy. Early intervention with a structured regimen, such as the COCOON protocol, may prevent progression of cutaneous toxicity, preserve skin integrity, and support adherence to life-prolonging oncologic treatments. Proactive collaboration between oncology and dermatology teams is essential in optimizing outcomes for high-risk patients receiving targeted cancer therapies.

instability. After successful resuscitation, she experienced a second cardiac arrest

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2026 Research Recognition Day