A pair from the Wayne State University School of Medicine will host individual presentations at the American College of Physicians' Internal Medicine 2014 meeting April 10-12 in Orlando, Fla. Both will chronicle the diagnosis and management of relatively rare conditions.
Tina Ozbeki, a third-year medical student and Detroit resident, wrote a clinical vignette about a patient she saw during her first month of an internal medicine rotation.
"She has sickle cell disease and received a blood transfusion, but unfortunately she ended up developing a complication - hyperhemolysis - from the blood transfusion," Ozbeki said.
She recognized that the case was rare, and, after writing about it for a class assignment, she researched hyperhemolysis. "There are many different types of adverse transfusion reactions, but hyperhemolysis is especially concerning because both the donor's red blood cells and the host's red blood cells are destroyed. It can lead to dangerously low hemoglobin levels," she said.
With help from the Department of Internal Medicine's Vice Chair for Education Diane Levine, M.D., and Assistant Professor Jarrett Weinberger, M.D., she turned her paper into the abstract "Recurrent Hyperhemolysis Syndrome in Sickle Cell Disease," and submitted it to the ACP. She is now working on the poster for her presentation.
"I was pretty excited to learn that I would be able to present this case. It is an honor. I'm excited to share what I've learned about hyperhemolysis syndrome," she said.
Dipenkumar Modi, M.D., a second-year internal medicine resident at WSU, will also attend the conference next month, presenting the abstract "Refractory Acute Fibrinous Organizing Pneumonia: A Diagnostic and Therapeutic Challenge in a Patient with Acute Respiratory Failure," about a patient who first sought help for a dry cough and difficulty breathing.
"She also had night sweats and unintentional weight loss for a year prior to hospitalization. Based on these complaints, she was admitted to the hospital. Blood, urine and sputum tests were performed and treatment with intravenous antibiotics for suspected pneumonia was started. Breathing did not improve despite antibiotics, and her condition was getting worse. She was transferred to the intensive care unit, where she was intubated and managed on mechanical ventilation for respiratory failure," he said.
A bronchoscopy - an endoscopic technique used to see the inside of the airways - was performed, but did not find any significant pathology, he added. An open lung biopsy was then performed, revealing the disease. It usually presents with influenza-like symptoms such as fever, cough, sore throat and weight loss, he added.
She was given intravenous steroids, the standard treatment of choice, he said, but after initial improvement, her symptoms returned and required repeat intubation and mechanical ventilation.
"Patients are often diagnosed late because presentation is very similar to pneumonia. Furthermore, it has variable radiographic presentations, which makes diagnosis very difficult. Usually they respond to steroid treatment, but very few patients do not. In that case, they require immunosuppressant agents," he said.
The patient finally improved after Dr. Modi, third-year internal medicine resident Hirva Mamdani, M.D., and Assistant Professor of Pulmonary and Critical Care Nader Mina, M.D., the attending physician on the case, paired the steroids with Mycophenolate, an immunosuppressive agent.
"This case was intellectually very challenging because of the dilemma it posed in diagnosing and managing it. Being a cerebral person, I am highly interested in this type of challenging case," he said.
Dr. Modi, a Detroit resident, also will present four unrelated posters at the upcoming Society of General Internal Medicine national conference April 23-26 in San Diego.