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| Medical students present their cases to faculty at the M3 Case Report Symposium. |
The symposium, hosted by the USA College of Medicine, drew 55 entries on cases involving a variety of diagnoses from cancer to infectious diseases.
Matthew Joyner earned first place for his presentation on the case of a patient with leiomyosarcoma, a rare malignancy, of the inferior vena cava (IVC), the largest vein in the body. This type of cancer can cause symptoms that mimic biliary disease, such as cholecystitis (inflammation of the gallbladder) or liver disease, such as Budd-Chiari syndrome.
“These types of cancers are primarily treated with surgery and involve operating on a major vessel, which can cause severe bleeding, as well as operating around other major organs like the liver, which is also highly vascularized,” Joyner said. “The patient who received this operation recovered well without complications and is now being seen as an outpatient for surveillance for cancer recurrence.”
Only 400 cases of leiomyosarcoma of the IVC have been reviewed in literature since 1871, said Joyner, who worked with surgical oncologist Spencer Liles, M.D., on the case.
Kasey Andrews earned second place for her report on the case of a 7-week-old infant who had been suffering from constipation since birth. The baby was treated in the emergency department after three days of worsening abdominal distension and projectile vomiting.
Because the child’s history of constipation had required treatment, doctors were concerned about infantile hypertrophic pyloric stenosis, a thickening of the muscle between the stomach and intestines, and Hirschprung’s disease, a condition in which missing nerve cells cause problems with passing stools. Andrews worked with pediatric gastroenterologist David Gremse, M.D., and pediatrician Brittany Mock, D.O., on the case.
After a normal rectal suction biopsy and endoscopic procedure, the infant’s final diagnosis was a severe milk protein allergy. “There were a few premises behind choosing this case including the concept that one diagnosis that can explain all symptoms a patient is experiencing is more likely to be the diagnosis than multiple diagnoses,” Andrews said. “It is more likely to find an uncommon presentation of a common disease than a common presentation of an uncommon disease.”
Donavon Dahmer took third place for his report on a case involving a woman with metastatic melanoma in the liver. As the patient was starting her second round of immunotherapy, she reported problems with vision, including eye discomfort in bright light and cloudy vision. She also suffered from hearing loss, hair loss and white streaks in her hair and eyelashes. In addition, there were signs of inflammatory cell deposits.
Doctors ruled out infectious and metastatic causes and diagnosed her with secondary noninfectious iridocyclitis (OU), acute inflammation of the iris and ciliary body, in both eyes. However, after reviewing her immunotherapy medications, they suspected that the patient’s condition was a side effect of the drug combination Nivolumab/Ipilimumab, described by the FDA to cause symptoms that manifest like Vogt-Koyanagi-Harada (VKH) disease, a multisystem autoimmune inflammatory disorder.
The patient was placed on high-dose steroid drops, and later was switched to the chemotherapy and immunosuppressive drug Methotrexate because of complications. Her condition then began to improve and stabilize.
“As an aspiring ophthalmologist, it was a pleasure writing up this case,” said Dahmer, who worked with ophthalmologists Jeffery St. John, M.D., and Christopher Semple, M.D., on the case.
Rising fourth-year medical student Samuel Thomas organized the event, which was the first in-person M3 Symposium since 2019.
“We’re super excited to have this event in person,” Thomas said. “This is a great opportunity for medical students to get experience presenting our case reports.”
