Rapides Regional Medical Center

Dissecting cellulitis of the scalp, also commonly referred to as dissecting folliculitis, is a rare, chronic, relapsing, suppurative disease characterized by painful nodules, purulent drainage, burrowing, and interconnecting abscesses. Dissecting cellulitis disproportionately affects Black males in early and mid-adulthood and may result in cicatricial alopecia, scarring disfigurement, and impaired quality of life. This narrative introduces a representative case of dissecting cellulitis in an adult Black male, summarizes the epidemiology, etiology, pathology, and evaluation of the condition, reviews evidence-based best practices for management and interdisciplinary consultation, and highlights racial disparities associated with the disorder. By shedding light on dissecting cellulitis, this case report aims to facilitate early diagnosis, optimal management, and favorable outcomes for this progressive and debilitating condition.

Amyloidosis is a rare and severe disease process that is often systemic in nature. Clinical presentations of patients include involvement of various organ systems such as the kidneys, heart, and lungs. As such, presentations of amyloidosis can be peculiar and can greatly mimic other conditions, making diagnosis very difficult. Delays in diagnosis or misdiagnoses can lead to significant morbidity and great potential for multi-organ dysfunctions.We describe the case of an elderly female patient without a known cardiac history who presented to the emergency department with increasing shortness of breath. This patient had a recent history of renal amyloidosis requiring regular chemotherapy. The patient was found to have extensive secondary fluid buildup in the pleural space, resulting in recurrent pleural effusions requiring repeated thoracenteses. Pleural effusions are rare complications of systemic amyloidosis that are poorly understood. After thorough evaluation of the cardiac and renal systems and ruling out malignancy, we suspected that direct infiltration of the pleura with amyloid fibrils and exacerbation of fluid overload from renal failure led to the disease presentation. With proper management of the patient’s end-stage renal disease with dialysis, the fluid-overload state with loop diuretics, and effective use of thoracentesis, the patient’s condition showed improvement. This report serves to educate on the pathophysiology of amyloidosis and provide a clinical anecdote of the presentation, course of this chronic disease process, treatment methodologies, and future of therapy.

Prurigo nodularis is a chronic dermatologic condition typically presenting as firm, dome-shaped pruritic nodules of various sizes that are often symmetrically distributed on extensor surfaces of the extremities. The diagnosis is clinical and based on a history of chronic, severe pruritis in the setting of characteristic, excoriated lesions. Treatment is difficult and aimed at reducing skin irritation and pruritus. Quality of life is impacted due to the chronic, intractable, and relapsing nature of the disease. Here, we report a case of prurigo nodularis diagnosed in the outpatient clinic setting. This paper aims to report the patient's clinical history, presentation, and histopathologic findings, as well as present a literature review to determine the significance of this case and the approach to ongoing management.

Abstract Disclosure: H. Shaka: None. A. Ilelaboye: None. E. Krishnaraju: None. M. Dasgupta: None. A. Shaka: None. P. Kanemo: None. Introduction: The COVID-19 pandemic exacerbated significant health disparities among adults in the US. Obesity has been on the rise in the US for decades and has been described as a pandemic. Morbid obesity (MO) is a known risk factor for worse outcomes for viral pneumonia including SARS-CoV-2. This study outlined the national impact of the COVID-19 pandemic on the ongoing obesity pandemic and assessed possible healthcare disparities in this population. Methods: The study obtained data from the US National Inpatient Sample from 2016 - 2020. This provides a nationally representative estimate of all US hospitalizations for each calendar year. We assessed rates of MO hospitalizations per 1000 adult hospitalizations yearly. We compared outcomes between 2019 and 2020 to evaluate the COVID-19 pandemic's effect on this population. Outcomes were also stratified by sex, race, and median household income. Results: From 2016 to 2020, hospitalizations involving adults with MO increased by 61%. While national hospitalizations dropped by about 9% in 2020, those involving adults with MO increased by 7.1% compared with 2019 adjusted for age, race, sex, and comorbidity index. In 2020, hospitalized adults with MO had a lower mean age and a higher proportion of men compared to 2019. There was no significant difference in the race, income and comorbidity index distribution of the patients in 2020 compared to 2019. Among adults with MO who died during hospitalization in 2020, about 1 in 5 had COVID-19 as the reason for admission. The mortality rate in all adults with MO increased from 1.5 to 2.7%. This represented an 84.5% higher odds of mortality compared to 2019. Stratification showed that there was an 80.0 vs 88.9% higher mortality in females vs males. Mortality in Hispanics increased by 169.7%, compared to 111.7% in Blacks and 66.8% in Whites. Patients in the lowest income quartile had an increase of 97.2 vs 61.7% in the highest income quartile. There were also significant regional variations in the increase in mortality among hospitalizations with MO. Year on year, total hospitalization charges in the studied population increased by $10 billion to over $156 billion, adjusted for inflation. The year 2020 also saw an overall increase in the length of hospitalizations for adults with MO. Discussion/conclusion: This study provides evidence that at the national level, patients with MO were significantly impacted by the COVID-19 pandemic. This contributed to significant healthcare costs. We recommend a national approach and response to the obesity pandemic as people with morbid obesity are projected to make up to 30% of the US population by 2030. We also highlighted significant racial and economic disparities in the outcomes of these patients. Although the reasons for such disparities are likely multifactorial, this adds to a growing body of evidence of disparities in healthcare across various health conditions. Presentation: Friday, June 16, 2023

The coronavirus disease 2019 (COVID-19) pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases. However, little focus has been given to its effect on cancer treatment. To determine the effect of COVID-19 pandemic on cancer patients' care. A retrospective review of a Nationwide Readmission Database (NRD) was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy (IPCT) during the COVID-19 pandemic in 2020. Two cohorts were defined based on readmission within 30 d and 90 d. Demographic information, readmission rates, hospital-specific variables, length of hospital stay (LOS), and treatment costs were analyzed. Comorbidities were assessed using the Elixhauser comorbidity index. Multivariate Cox regression analysis was performed to identify independent predictors of readmission. Statistical analysis was conducted using Stata® Version 16 software. As the NRD data is anonymous and cannot be used to identify patients, institutional review board approval was not required for this study. A total of 87755 hospitalizations for IPCT were identified during the pandemic. Among the 30-day index admission cohort, 55005 patients were included, with 32903 readmissions observed, resulting in a readmission rate of 59.8%. For the 90-day index admission cohort, 33142 patients were included, with 24503 readmissions observed, leading to a readmission rate of 73.93%. The most common causes of readmission included encounters with chemotherapy (66.7%), neutropenia (4.36%), and sepsis (3.3%). Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts. The total cost of readmission for both cohorts amounted to 1193000000.00 dollars. Major predictors of 30-day readmission included peripheral vascular disorders [Hazard ratio (HR) = 1.09, P < 0.05], paralysis (HR = 1.26, P < 0.001), and human immunodeficiency virus/acquired immuno-deficiency syndrome (HR = 1.14, P = 0.03). Predictors of 90-day readmission included lymphoma (HR = 1.14, P < 0.01), paralysis (HR = 1.21, P = 0.02), and peripheral vascular disorders (HR = 1.15, P < 0.01). The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT. These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.

Amelanotic malignant melanoma (AMM) is a skin cancer that arises from mutated melanocytes that lack pigmentation. AMM represents 2-8% of all malignant melanomas. This rare subtype is difficult to diagnoseclinically as it mimics other benign skin lesions. AMM can occur in any part of the body with various presentations and has a predilection for male gender and fair skin tones. We present a case report of a 62-year-old Caucasian male with AMM of the right lower extremity. The patient presented with a painless nodule on his right lower extremity that rapidly increased in size for seven months with no signs of malignancy, such as fever, night sweats, fatigue, bruising, weight loss, or headache. Simultaneously, the patient presented with right inguinal lymphadenopathy and pitting edema of the right lower extremity. The patient had a previous medical history of basal and squamous cell carcinoma and psoriasis with no personal or family history of melanoma. The mass was excised and sent to a pathologist along with a right inguinal sentinel lymph node biopsy. The final pathology report revealed an ulcerated AMM on the right lower extremity and a positive node for melanoma with a metastatic deposit. The patient underwent adjuvant immunotherapy resulting in the clearance of the cancer cells. This report highlights the importance of early diagnosis, appropriate surgical management, and adjuvant therapy to improve the prognosis of this rare melanoma subtype.

e16318 Background: Pancreatic cancer patients have a strong risk of Deep Venous thrombosis (DVT). Pulmonary Embolism (PE) can be a fatal complication of DVT. Both DVT/PE increases the risk of hospitalization and subsequent readmission. National population-based studies are scarce on DVT/PE readmissions among pancreatic cancer patients in the United States (U.S). In this study, we aim to describe the rate, reasons for readmissions, and outcome of readmissions for pancreatic cancer patients hospitalized for DVT/PE in the U.S. Methods: We analyzed the 2018 Nationwide Readmissions Database (NRD). It includes nested and weighted discharge data for 60% of the total U.S population from 28 states. These data are stratified in clusters to produce national estimates. The NRD captures admissions on a calendar-year basis without links to the following or preceding year. We included index hospitalizations for all pancreatic cancer patients (aged ≥18 years) admitted principally for DVT/PE using the International Classification of Diseases (ICD)-10 codes. We excluded elective and traumatic readmissions. 30-day readmission was calculated as the percentage of patients readmitted within 30 days over index hospitalizations that were discharged alive. Using a "rank" command in STATA, the most common reasons for readmission were outlined. Logistic regression was used to compare inpatient mortality between readmissions and index hospitalizations. STATA, 16 was used for analysis. Since NRD contains de-identified patient data, Institutional Review Board (IRB) review was not sought. Results: A total of 2339 index hospitalizations for DVT/PE among pancreatic cancer patients were discharged alive. Among these, 510 (21.8%) were readmitted within 30 days. The top 5 reasons for 30-day readmissions were sepsis, pancreatic cancer, PE without cor pulmonale, metastatic cancer of the liver and intra-hepatic duct, and pneumonia. 30-day readmissions were responsible for an aggregate of 5.9 million U.S dollars in hospital costs and 2443 hospital days in 2018. Compared to index hospitalizations, 30-day readmissions had higher inpatient mortality (13.4% vs 5.9%, p &lt; 0.0001). Conclusions: 30-day readmissions for DVT/PE in patients with pancreatic cancer have a significant healthcare economic burden. PE, Pancreatic cancer, and infections were common reasons for readmissions. Readmissions have significantly greater inpatient mortality compared to index admissions. Adequate management of DVT/PE and underlying malignancy during index admissions and ensuring timely outpatient follow-up are important in reducing 30-day readmissions of these patients.

e18821 Background: Kaposi sarcoma (KS) is a type of soft tissue sarcoma due to infection with human herpes virus 8 (HHV-8) and can be associated with acquired immunodeficiency syndrome [AIDS]. Recent national population data are scarce on reasons for hospitalizations, epidemiology, and hospitalization outcomes of patients with KS in the United States (U.S). Methods: Data were abstracted from the National Inpatient Sample (NIS) Database. This database is the largest collection of inpatient admission data in the U.S. It is a 20-percent stratified sample of all discharges from U.S. community hospitals, excluding rehabilitation and long-term acute care hospitals. The numbers in the databases are weighted to optimize national estimates. Hospitalizations for patients with KS were obtained by searching for hospitalizations that contained ICD-10 code “C46” as a principal or secondary diagnosis. The principal diagnosis is the main reason for the admission, while any other diagnosis other than the principal, are secondary diagnosis. The reason for hospitalization (or principal diagnosis) was recorded in descending order of frequency based on the ICD-10 code organ system category and specific principal diagnosis. The total number of KS discharges, baseline demographic characteristics, hospital length of stay (LOS), and total hospital charges were recorded. STATA 16 was used for analysis. Since NIS contains de-identified data, Institutional Review Board (IRB) review was waived. Results: There were 32 million discharges included in the 2020 NIS database. Of those, 2,785 hospitalizations were for patients aged ≥18 years, who had either a principal or secondary ICD 10 code for KS. Patients were mainly males (91%), black (40%), mean age of 48 years, inpatient mortality of 9.3%, mean LOS of 9 days, and mean total hospital charge of 132,476 U.S dollars. The 5 most common reasons for hospitalization by ICD 10 code categories were infections (52.4%), cardiovascular (6.5%), respiratory (6.1%), neoplasm and hematologic (5.6%), and skin (5.6%). The 5 most common specific principal diagnoses for hospitalizations were Human immunodeficiency virus [HIV] disease (29.1%), sepsis (12.7%), left leg cellulitis (2.7%), pneumonia (2.2%), and Acute kidney injury (1.8%). Conclusions: Hospitalizations for KS patients are mostly black middle-aged men, with high inpatient mortality, long LOS, and significant hospital charges. Infections and HIV were the most common reasons for hospitalizations. Management of underlying HIV and measures for prevention, early detection, and prompt treatment of infections in the outpatient setting are important in preventing hospitalizations of these patients.

Emphysematous pyelonephritis is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma, collecting system, or perinephric tissue. The management of emphysematous pyelonephritis mainly depends on the extent of the disease.In this report, we present the case of a 48-year-old male who presented with left flank pain and imaging findings of left-sided emphysematous pyelonephritis with extensions of air into the pararenal space as well as a 5.6 cm bladder stone and severe right-sided hydroureteronephrosis. He initially received bilateral nephrostomy tubes, a left-sided perinephric draining tube, and intravenous antibiotics; however, his symptoms persisted. Ultimately, the patient underwent open cystolitholapaxy and left nephrectomy, with eventual resolution of symptoms.

e19014 Background: Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative therapy for acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) but relapse and graft versus host disease (GVHD) remain the most common challenges. Donor lymphocyte infusion (DLI) is the infusion in which lymphocytes from the original stem cell donor are infused, after the transplant, to augment an anti-tumor response or to ensure that the donor stem cells remain engrafted. In this systematic review and meta-analysis, we focused at outcomes of preemptive DLI in AML and MDS. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA) PubMed, CINAHL, Cochrane, and Clinical trials.gov were searched. We included 8 out of 214 articles, excluding duplicates and non-relevant articles. The quality of the included studies was evaluated using NIH quality assessment tool. Proportions along with 95% Confidence Interval (CI) were extracted to compute pooled analysis using the ‘meta’ package by Schwarzer et al. in the R programming language (version 4.16-2) to report the efficacy of preemptive DLI. We pooled the experimental arms results of the included trials using the inverse variance method and logit transformation. Between studies, the variance was calculated using Der Simonian-Laird Estimator. Results: We identified 222 patients who received preemptive DLI. Median age, time since transplant and DLI dose were 48 (32-58) years, 82 (7-160) days and 1.4 million cells/kg respectively. CR and PR were 43% (95%CI 0.14-0.78, I293%, n= 127) and 61% (95%CI 0.40-0.78, I262%, n= 81) respectively. After median follow up of 46 months, non-relapsed mortality (NRM) was 52% (95%CI 0.38-0.65, I249%, n = 121). OS was reported 72% (95%CI 0.62-0.80, I20%, n= 100). Acute and chronic GVHD incidence after DLI was 20% (95% CI 0.13-0.29, I24%, n= 105) and 25% (95% CI 0.08-0.56, I2=79%, n=101) respectively (Table). Conclusions: Preemptive DLI significantly improves OS with a low incidence of acute and chronic GVHD. However, NRM was seen in more than half of all the patients and prospective studies are needed to evaluate safety of preemptive DLI. Outcomes with preemptive DLI (n= 222).[Table: see text]