Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Christine Le, MS 1 ; Sabeen Wazir, BS 1 ; Ana Jones, BS 2 ; John Lipka, MD 1 ; Jonas Rawlins, DO 3 1 VCOM-Louisiana; 2 VCOM-Auburn; 3 VCOM-Virginia 79 CHALLENGES AND APPROACHES TO THE TREATMENT OF PSORIASIS IN A DEVELOPING COUNTRY: A CASE REPORT

Jackson Moffatt, OMS-III; Matthew Overturf, PhD VCOM-Louisiana 80 PAINLESS OPTIC NEURITIS AS THE INITIAL PRESENTATION OF MULTIPLE SCLEROSIS: A CASE REPORT

Context: Psoriasis vulgaris is a chronic immune-mediated disease with substantial physical, psychological, and socioeconomic burdens. In developing countries, limited dermatologic resources and restricted access to systemic therapies contribute to delayed diagnosis, severe disease presentations, and poorer clinical outcomes. Report of Case: A 22-year-old Dominican male presented to a dermatology outreach clinic in Punta Cana with advanced plaque psoriasis involving the face, scalp, neck, trunk, and bilateral extremities. Examination revealed numerous erythematous and scaly papules, patches, and plaques with psoriatic nail changes of the hands and feet. The Patient-Oriented Psoriasis Area and Severity Index (PO-PASI) was 18.2, consistent with severe chronic plaque psoriasis. Although diagnosed two years prior, the patient had been unable to access dermatologic care due to geographic barriers (nearest hospital three hours away) and socioeconomic limitations. He reported partial symptomatic relief with emollients. Limited workup was available due to resource constraints. Management

consisted of continuation of emollient therapy for symptomatic relief, a short course of doxycycline 100 mg twice daily, and referral to a regional dermatologist for evaluation for biologic therapy. Home-kit treatments were discussed to reduce care disruption and support adherence. Conclusion: This case highlights the challenges of managing complex dermatologic disease in resource-limited settings, including infrastructural gaps, geographic barriers, and the limited scope of outreach clinics. The clinical presentation demonstrated overlapping guttate like and plaque features, raising consideration of progression from post-infectious guttate psoriasis to chronic plaque disease. The use of doxycycline remains controversial, as limited evidence supports its efficacy for plaque-type psoriasis. Psoriasis in patients with darker skin tones may appear violaceous or gray rather than salmon-colored, contributing to diagnostic delay and undertreatment. Broader strategies that address socioeconomic, psychological, and systemic barriers are needed to improve dermatologic care in developing countries and to promote culturally appropriate diagnostic and treatment guidelines.

Context: Optic neuritis is a common initial manifestation of multiple sclerosis, typically featuring painful unilateral vision loss. Atypical forms, such as painless onset or persistent severe vision deficit, are rarer but clinically significant, as they may delay diagnosis or mimic other optic neuropathies. Early recognition via multimodal imaging is essential for initiating disease-modifying therapy. Report of Case: A 45-year-old otherwise healthy female presented with acute painless vision loss in the right eye to counting fingers over 4 days. Examination revealed a relative afferent pupillary defect and optic disc pallor without edema. Optical coherence tomography showed marked peripapillary retinal nerve fiber layer thinning. Orbital and brain MRI disclosed enhancing right optic nerve lesion plus multiple T2-hyperintense periventricular and juxtacortical plaques. Cerebrospinal fluid analysis confirmed oligoclonal bands. Treatment with high-dose intravenous methylprednisolone followed by oral prednisone taper yielded only modest improvement, with final best-corrected visual acuity of 20/150 at 6-month follow-up.

Conclusion: This case highlights an atypical painless Optic Neuritis variant in Multiple Sclerosis leading to significant residual visual impairment, contrasting with the usual prognosis. It emphasizes the diagnostic utility of OCT for axonal loss quantification, MRI for CNS demyelination confirmation, and prompt neurology referral. Such presentations underscore the need for heightened suspicion of MS in subacute vision loss without pain, facilitating earlier intervention to prevent further relapses and disability progression.

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2026 Research Recognition Day