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ABSTRACTS 17 Annual Southern Hospital Medicine Conference ADDITIONS Ochsner Journal 17:e1–e82, 2017 Ó Academic Division of Ochsner Clinic Foundation ABSTRACTS 17th Annual Southern Hospital Medicine Conference October 13-15, 2016 Ochsner Clinic Foundation / Emory University School of Medicine New Orleans, LA CLINICAL VIGNETTES ABSTRACTS e3-e74 QUALITY INNOVATIONS-RESEARCH ABSTRACTS e75-e82 Volume 17, Number 1, Spring 2017 e1 17th Annual Southern Hospital Medicine Conference Abstracts 17th Annual Southern Hospital Medicine Conference Clinical Vignette and Quality Innovations-Research Poster Session Award Winners Clinical Vignettes Abstracts 1st Place Amirhossein Esmaeeli Neuropsychiatric Lupus: Uncovering the Great Medical EmoryUniversityHospital Masquerader (abstract 72) Atlanta, GA 2nd Place Thuy-Van Tina Pham Pick Your Poison: A Diagnosis Masked by Alcoholic Emory University School of Medicine Pancreatitis (abstract 57) Atlanta, GA 3rd Place Charles Terry An Unusual Case of Ascites: Primary Effusion Lymphoma Emory University School of Medicine Presenting as Spontaneous Bacterial Peritonitis in an HIV- Atlanta, GA Negative Male (abstract 56) Honorable Sumant Arora Danger of Prescription Drugs: An Uncommon Adverse Mention University of Alabama at Birmingham Medical Reaction (abstract 67) Center-Montgomery Montgomery, AL Honorable Deebah Ashraf Uddin Pleural and Peritoneal Chylous Effusions: Rare Manifestation Mention East Carolina University/Vidant Medical Center of Kaposi Sarcoma (abstract 60) Greenville, NC Honorable Joseph Coffman Left Ventricular Thrombus in Heart Failure With Reduced Mention University of South Florida Ejection Fraction (abstract 39) Tampa, FL Honorable Maria Gutierrez Malignant Coronary Artery: An Uncommon Entity of Mention University of Florida-Jacksonville Recurrent Chest Pain (abstract 18) Jacksonville, FL Honorable Neha Hingorani Idiopathic Orbital Inflammatory Syndrome (abstract 71) Mention University of Alabama at Birmingham Birmingham, AL Honorable Grant Nelson Encapsulating Peritoneal Sclerosis in a Renal Transplant Mention University of Florida-Jacksonville Patient With Extensive Peritoneal Dialysis (abstract 3) Jacksonville, FL Honorable Rohit Jain Lyme Disease–Induced Bradycardia (abstract 25) Mention Western Maryland Health System Cumberland, MD Honorable Michele Sundar Altered Mental Status and Anuria: A Rush for Diagnosis Mention Emory Saint Joseph’s Hospital (abstract 8) Atlanta, GA Honorable Sean Verma Disseminated Adenovirus Causing Tubulointerstitial Mention University of South Florida Nephritis in a Renal Allograft Patient (abstract 46) Tampa, FL Honorable Brittany Lyons Pacreaticopleural Fistula in Chronic Pancreatitis (abstract 29) Mention University of Florida-Jacksonville Jacksonville, FL Quality Innovations-Research Abstracts 1st Place Melissa Stevens EQUiPPED Expansion: Results from a Multisite Quality Veterans Affairs Geriatric Research Education Improvement Initiative to Change Prescribing Practices in and Clinical Center Veterans Affairs Medical Center Emergency Departments Birmingham, AL and Atlanta, GA (abstract 74) Emory University Decatur, GA 2nd Place Rumman Langah Utility of Power Plan in Standardizing Care of Hospitalized EmoryUniversityHospital COPD Patients (abstract not published at author request) Atlanta, GA 3rd Place Meg Zoffuto Creation of a Hospital Medicine Service Handover Tool Vanderbilt University Medical Center (abstract 80) Nashville, TN Honorable Ingrid Pinzon Continuous Cardiac Monitoring in Hospital Settings Mention Emory Saint Joseph Hospital, Emory University (abstract 75) Atlanta, GA e2 Ochsner Journal 17th Annual Southern Hospital Medicine Conference Abstracts CLINICAL VIGNETTES ABSTRACTS 1 Anti-Synthetase Syndrome: An Important Consideration in Dyspnea Stuart Shah, MD; Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL Grant Nelson, DO; Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL Ozdemir Kanar, MD; Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL Pramod Reddy, MD; Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL Case Presentation: A 49-year-old male with no relevant medical history presented with complaints of worsening dyspnea and bilateral upper extremity weakness present mostly in his hands. He was admitted to the ICU for hypoxic respiratory failure not requiring intubation. On physical examination his hands were noted to be very dry with thickened skin and cracking that started around the same time as his dyspnea. Chest x-ray showed patchy opacities in the lower lobes concerning for pneumonia and pleural effusions that were confirmed by CT scan. However, given the constellation of complaints, there was a high suspicion for myositis-related interstitial lung disease (ILD). He was started on high-dose steroids and had dramatic improvement in his weakness. Creatine kinase (CK) levels drawn were elevated and the patient was also found to be anti-Jo-1 and anti-SSA/Ro antibody positive. Lung biopsy showed findings associated with ILD. He was diagnosed with the rare condition of antisynthetase syndrome (ASS) and continued on steroid therapy with almost complete resolution of his symptoms prior to discharge. Discussion: ASS is a rare phenomenon that can be present in up to 30% of patients who are initially diagnosed with dermatomyositis or polymyositis. It is characterized by a constellation of clinical findings that include fever, weight loss, myositis, polyarthritis, ILD, thickening and cracking of the hands (mechanic’s hands), and Raynaud phenomenon. Antibodies to aminoacyl-transfer ribonucleic acid synthetase enzymes are seen, with anti-Jo-1 antibody being the most common (68%-87% of cases). The syndrome is considered to be present as long as the antisynthetase antibody is present plus any 2 of the following symptoms: ILD, inflammatory myopathy, or inflammatory polyarthritis. Conclusion: The patient presentation was initially concerning for pneumonia, which was further confirmed by 2 forms of imaging. However, complaints of upper extremity weakness and skin changes warranted further investigation, prompting additional laboratory workup that returned an elevated CK, a positive antisynthetase antibody, and positive lung biopsy for ILD. ASS is debilitating and caries a poor prognosis if not identified and treated promptly. By careful clinical investigation, the correct diagnosis was made promptly, and the patient was treated successfully. Volume 17, Number 1, Spring 2017 e3 17th Annual Southern Hospital Medicine Conference Abstracts 2 A Late and Uncommon Presentation of Combined Pulmonary Infundibular Stenosis and Large Atrial Septal Defect Stuart Shah, MD; Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL Grant Nelson, DO; Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL Ozdemir Kanar, MD; Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL Case Presentation: A 59-year-old female with a medical history significant for hypothyroidism presented with sudden-onset dyspnea and lightheadedness. In the ED, ECG demonstrated new-onset atrial fibrillation with rapid ventricular response. Patient was started on an esmolol infusion for rate control, which led to return of sinus rhythm. Follow-up ECG revealed large P waves consistent with right atrial enlargement. Thyroid-stimulating hormone level was within normal limits. TTE and TEE revealed a large primum atrial septal defect (19 mm), large secundum atrial septal defect (23 mm), severe pulmonary infundibular obstruction, and marked right atrial enlargement. Coronary angiogram showed mild nonobstructive coronary artery disease. The patient’s initial presentation of new-onset atrial fibrillation was likely secondary to the marked right atrial enlargement. Discussion: Pulmonary infundibular stenosis with an associated large atrial septal defect is a relatively rare form of congenital heart disease. It presents in early adulthood, late 20s to early 30s, with symptoms of dyspnea, edema, jugular venous distension, and/or cyanosis secondary to elevated pulmonary arterial pressure and heart failure. This is a direct result of significant left to right shunting through the atrial septal defect. The presence of pulmonary infundibular stenosis initially protects the pulmonary vasculature from any significantly elevated pressures caused by the left to right shunt by outflow obstruction, but this is eventually overcome with time, causing a later presentation in early adulthood. Conclusion: Age 59 is a relatively late presentation of congenital heart disease, and this patient also had the atypical symptom of atrial fibrillation. This case demonstrates a very well-balanced congenital shunt secondary to pulmonary infundibular obstruction. Both of these defects are easily corrected with percutaneous intervention that can be done at the same time. e4 Ochsner Journal 17th Annual Southern Hospital Medicine Conference Abstracts 3 Encapsulating Peritoneal Sclerosis in a Renal Transplant Patient With Extensive Peritoneal Dialysis Grant Nelson, DO, MPH; Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL Stuart Shah, MD; Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL Reem Louli, MD; Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL Jason Arthur, MD, MPH; Department of Emergency Medicine, University of Florida-Jacksonville,
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