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| Medical student Jessica Irvin, with her faculty sponsor Grace Hundley, M.D., took first place at the M3 Case Symposium. |
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William Smith discusses his poster with Anne-Marie Kaulfers, M.D., and Benjamin Estrada, M.D. |
Five attending physicians judged the posters based on originality, strength of conclusions, quality of references, overall appearance, organization and topic. Medical students Krisha Amin and Walker Phillips planned this year’s event.
Jessica Irvin won first place for her poster on the effects of suspected naphthalene ingestion. A 15-month-old boy presented to the emergency department in shock with hemolytic anemia, acute kidney injury, lactic acidosis, and respiratory distress requiring intubation. He also developed difficulty balancing and walking. The cause of illness was unknown until over a week and a half into hospitalization when further history was obtained from the parents.
“They told us that right before the patient got sick, he was seen eating dirt from the yard that was recently treated with a snake pesticide,” Irvin said. Naphthalene is the main ingredient in snake pesticide but is more commonly known as the main ingredient in mothballs. Published case reports of naphthalene toxicity after mothball ingestion describe findings that matched the presentation of the patient.
“This case is interesting because it is the first to identify snake pesticide as a source of naphthalene toxicity,” Irvin said. “It is also a great example of the importance of thorough history taking, because we would not have been able to figure out the cause of the patient’s illness without the additional history from the parents.”
Irvin worked with Grace Hundley, M.D., assistant professor of internal medicine and pediatrics, on her case report presentation. “I feel very grateful for being named the top presenter and for having the opportunity to share such an interesting case with the Whiddon College of Medicine community,” she said.
Diana Bucio received second place for her presentation of a pediatric case of stage III nasopharyngeal carcinoma. A 12-year-old girl underwent five months of chemotherapy and radiation before achieving remission. Typically, nasopharyngeal carcinoma is associated with Epstein-Barr virus (EBV), a common virus that most people carry without harm, but in rare cases it can cause genetic changes in cells that make them more likely to become cancerous.
Hamayun Imran, M.D., a pediatric hematologist/oncologist and professor of pediatrics, and Elizabeth Manci, M.D., professor of pathology, served as Bucio’s faculty mentors.
“We chose to present this case because the tumor, when biopsied, was positive for HPV16, a high-risk strain of human papillomavirus that is most commonly associated with causing cervical cancer,” Bucio said. “Although her treatment regimen was the same even if it had been EBV-positive, data has shown that the cases of HPV-positive nasopharyngeal carcinoma have better overall prognosis than the more common EBV-positive associated.”
Matthew Kelley took third place for his case report on Warthin-like mucoepidermoid carcinoma (MEC), an extremely rare salivary gland tumor, with only 28 reported cases since 2015. The diagnosis was made in a 9-year-old male, the youngest known case to date. This malignant tumor can easily be mistaken for a benign one, posing a risk for inappropriate treatment and follow-up.
Kelley’s presentation focused on using histology and fluorescence in situ hybridization (FISH) analysis to differentiate Warthin tumors from Warthin-like MECs. FISH is a lab-based technique used for locating specific DNA sequences, diagnosing genetic diseases, gene mapping, and identifying oncogenes or chromosomal abnormalities contributing to various types of cancers.
Kelley worked with Percy Van Crocker, M.D., an ENT surgeon and assistant professor of pediatrics, on his case report. “Presenting this unique case was especially rewarding given its relevance to the field of ENT, which is the specialty I’m pursuing,” Kelley said.
