Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Katia Castillo, OMS-IV 1 ; Jacob Morgan, OMS-IV 1 ; Christian Wold, MD 2 ; Eric Reish, MD 3 ; Thomas Norton, MD 3 ; Bruce Herrington, MD 4 ; Bryce Beard, MD 4 ; Joe Screpetis, MD 5 1 VCOM-Louisiana; 2 Red River ENT, Alexandria, Louisiana; 3 Louisiana Eye and Laser, Alexandria, Louisiana; 4 Rapides Regional Medical Center, Alexandria, Louisiana; 5 The Clinics, Alexandria, Louisiana 83 A SERIES OF UNFORTUNATE EVENTS: THE DISCOVERY OF OROPHARYNGEAL CANCER THROUGH A COMPLICATED PATIENT COURSE

Sahana Padumane, OMS-III 1 ; Sophie Qui, OMS-III 1 ; Zachariah Francois, DO 2 1 VCOM-Louisiana; 2 Opelousas General Behavioral Rural Health Clinic, Opelousas, Louisiana 84 CATATONIA MISTAKEN FOR HEBEPHRENIC TYPE SCHIZOPHRENIA IN NONVERBAL PATIENT

Context: The patient underwent a computed tomography (CT) angiogram of the head and neck, which demonstrated no evidence of malignancy. Despite negative imaging, an incidental diagnosis of squamous cell carcinoma of the right palatine tonsil was subsequently made. As the prevalence of malignancies and chronic diseases continues to rise, maintaining a high index of suspicion for life-threatening conditions remains essential. Report of Case: A 76-year-old male with a past medical history of hypercholesterolemia, hypothyroidism, coronary artery disease, and hypertension initially presented to an ophthalmologist with sudden vision loss in the right eye. Visual field testing revealed a right unilateral inferior hemianopia. Fundoscopic examination demonstrated cholesterol emboli within the superior retinal arcade with corresponding superior retinal atrophy. Given concern for embolic disease, the patient underwent carotid ultrasonography, which revealed an 80–99% stenosis of the right internal carotid artery. He was subsequently referred to his primary care physician and then to cardiothoracic surgery. A CT angiogram of the

head and neck confirmed severe atherosclerotic disease but demonstrated no evidence of malignancy or other abnormalities. The patient underwent right internal carotid endarterectomy. Intraoperatively, the cardiothoracic surgeon noted cervical lymph nodes of suspicious appearance, which were excised and sent for pathologic evaluation. Histopathologic analysis revealed malignant epithelial cells consistent with metastatic carcinoma. The patient was then referred to oncology, where positron emission tomography (PET) imaging demonstrated increased radiotracer uptake in the oropharynx. Otolaryngology evaluation followed, and the patient underwent tonsillectomy. Pathology identified squamous cell carcinoma of the right palatine tonsil as the primary source of malignancy. Following surgical excision, the patient received adjuvant radiotherapy and is in remission. Conclusion: Relevant studies were identified by using publicly available research databases such as Google Scholar and PubMed. Searched terms included “follow-up,” “oropharyngeal carcinoma,” “negative imaging,” and “incidental diagnoses of cancer.” Firstly, there were no

published articles reminiscent to the presented patient. This case appears to be unique in its clinical course. Cantrell et al. examined the radiologic differences of HPV-positive and HPV negative and reported that HPV-positive tumors are more hyperattenuated which highlights the atypical lack of radiologic evidence on this patient’s first image study (1). This is further confounded by the patient’s lack of neck or oral symptoms which precluded him from receiving an earlier diagnosis. In this case, the diagnosis relied heavily on the patient’s adherence to follow-up and the clinical acumen of his medical providers. Furthermore, the communication of each provider proved essential to the final diagnosis of oropharyngeal carcinoma.

Context: Alogia, colloquially known as Poverty of-Speech, is a term used to describe less frequent verbal communication in patients with primarily psychiatric or neurologic issues. It can be due to a variety of conditions, including Traumatic Brain Injury, Schizophrenia, Major Depressive Disorder, and many more. This symptom can pose a difficulty in diagnosis to healthcare providers due to the patient being unable to communicate to the provider. This case exhibits an unusual presentation of Catatonia and the difficulties providers can run into while assessing psychiatric and medical dysfunction in a patient unable to communicate well to them. We hope that documentation of this unusual case may assist other medical professionals in recognizing and treating Catatonia with more clinical confidence. Report of Case: In this case we describe a patient with Alogia and largely unknown medical history who had not been seen by a medical provider for more than 20 years prior to being transferred to a psychiatric hospital. Per the patient’s sister she had been nonverbal for approximately 10 years prior to her hospitalization. According to family

she had lost 150 pounds during an unknown amount of time. Her alogia and lack of a medical history led to a misdiagnosis at the psychiatric hospital of disorganized Hebephrenic type Schizophrenia, which was then treated with Haldol and Risperidol. This treatment then resulted in a worsening catatonic state and Acute Extrapyramidal Symptoms that necessitated her transfer to our hospital for treatment. At our hospital her diagnoses were amended to Catatonia and Drug-Induced Parkinsonism. She presented in a profound hypoactive catatonic state. Her catatonia was treated with Lorazepam, resulting in remarkable improvements such as diminished cogwheel rigidity and after her significant recovery of function as well as increase in weight, her diagnosis was confirmed as Catatonia. Her Lorazepam dose was limited by hypotension but her symptoms were improved enough to discharge her to outpatient follow up. Further work up tested positive for dsDNA antibodies and Rheumatoid factor and outpatient Lumbar puncture and serum encephalitis panel was negative. Further improvements were seen with outpatient treatment and her lorazepam was continued as well as Haldol and Risperidone

added back. She has been referred to Rheumatology due to her positive antibodies and continues to improve with outpatient follow up. Conclusion: This case highlights some of the roadblocks that rural health providers run into, specifically in a psychiatric setting. Due to this patient’s limited access to healthcare and resulting lack of medical history, a patient unable to communicate adequately to her providers was misdiagnosed. Her misdiagnosis and incorrect treatment with antipsychotic medications then resulted in Drug-induced Parkinsonism and caused further decline in her health. Thankfully through intervention by providers and family members taking care of her, her health is continuing to improve. The nature of psychiatric conditions is not conducive to consistent follow up and compliance with medications and thus poses an extra layer of complexity in treating patients who already have limited access. We hope that this unusual case and awareness of complexities involved in rural psychiatric care will educate current and future physicians to consider a broad differential when making psychiatric diagnoses.

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2026 Research Recognition Day