The Southwest Journal of Medicine

The efficacy of Polaroid photography in documenting dermatological treatment progression in resource-limited settings

Dora Goldstein — 2026-07-07

Accurate documentation of dermatological conditions is critical for assessing therapy efficacy, especially in free clinics where provider continuity and electronic health records (EHRs) are often unavailable. Polaroid instant photography offers a practical solution by providing tactile, confidential evidence that bridges the gap left by digital systems, which may be inaccessible or pose privacy risks. Serial photography with Polaroid cameras enables reliable monitoring of disorders such as psoriasis, vitiligo, and chronic ulcers, reducing diagnostic errors and facilitating clear inter-provider communication. While Polaroid images are best suited for larger lesions and pigmentary conditions, they offer advantages in patient confidentiality and ease of integration into paper-based workflows. Standardization of imaging protocols and secure handling of physical photographs are essential for maximizing benefits. Despite limitations such as cost and image durability, Polaroid photography presents a viable alternative in resource-limited settings, where it can significantly improve documentation quality over textual notes alone. Future research should evaluate its impact on diagnostic accuracy and patient outcomes in underserved populations.

Keywords: Polaroid photography, dermatology, free clinics, patient confidentiality, serial imaging

Pre-COPD and PRISM: Wrong definitions with significant clinical impact

Akhil Paul — 2026-07-07

‘Pre-COPD’ is defined as a high-risk state in individuals with symptoms like cough with sputum production and dyspnea, physiological abnormalities like low FEV1, faster decline of FEV1, low DLCO etc and radiological abnormalities like airway abnormalities and emphysema, with a normal FeV1/ FVC ratio in the spirometry. The term ‘PRISM--Preserved Ratio Impaired Spirometry’ was also introduced as a subset of Pre-COPD with FEV1 < 80%, but with preserved or normal FEV1/ FVC ratio. If a person is symptomatic with lung function test, radiology and even histology suggestive of COPD, how can we call them ‘Pre-COPD’ just because the spiromteric FEV1/FVC ratio did not fall less than 70% or below the 5^th percentile. There are various reasons why we might fail to demonstrate an airway obstruction just by FeV1/ FVC ratio alone. Overdependence on spirometry to define clinical terminologies in COPD can have adverse effects on the disease management. In this article, we discuss the pit falls in the definitions of ‘Pre-COPD’ and ‘PRISM’ and also the need of better clinical definitions in detail.

Keywords: Pre-COPD, PRISM, Spirometry, Oscillometry, COPD

Ventricular arrhythmias and in-hospital outcomes in non-elective coronary artery bypass graft in type 1 myocardial infarction: An analysis of the national inpatient sample

Chanokporn Puchongmart — 2026-07-07

Background: Malignant ventricular arrhythmias (VAs) are a serious complication of type 1 myocardial infarction (T1MI), yet their burden and impact on outcomes in patients undergoing urgent coronary artery bypass grafting (CABG) are not well established.

Objectives: We aim to identify the incidence and the prognostic impact of malignant VAs in patients undergoing non-elective CABG for T1MI.

Methods: A retrospective cohort study using the National Inpatient Sample from 2016 to 2022 was conducted by identifying all adult patients with T1MI who underwent non-elective CABG. Survey-weighted analyses were performed to compare baseline characteristics and outcomes between VAs and non-VAs groups. Multivariable logistic regression was used to evaluate the independent association between VAs and in-hospital mortality.

Results: Among 388,310 weighted hospitalizations for T1MI undergoing CABG, 10.0% had malignant VAs. Patients with VAs were younger (65.6 vs. 65.4 years, p < 0.01), less likely to be female (21.7% vs. 26.8%, p < 0.01), and had higher rates of comorbid conditions. The presence of VAs was associated with higher in-hospital mortality (11.2% vs. 2.7%), longer hospital stay (12 vs. 8 days), and increased incidence of acute kidney injury (40.9% vs. 27.8%, p < 0.01). After adjustment, VAs remained independently associated with increased odds of in-hospital mortality (aOR 2.90, 95% CI 2.62-3.21).

Conclusions: VAs occur around 10% in patients undergoing CABG for T1MI and are strongly associated with an increase in in-hospital mortality. These findings underscore the importance of perioperative monitoring and management of VAs in this high-risk population.

Keywords: Ventricular tachycardia, ventricular fibrillation, myocardial infarction, coronary artery bypass graft

H5N1 avian influenza in Texas: Comprehensive regional report

Asmaa Beltagy — 2026-07-07

Post-COVID-19 acquired myasthenia gravis: A review of reported cases

Leila Laouar — 2026-07-07

Introduction: The emergence of cases of myasthenia gravis (MG) following SARS-CoV-2 infection suggests a potential triggering role of COVID-19 in the onset of this autoimmune disorder.

Objective: This literature review aims to synthesize the available evidence on the clinical, paraclinical, therapeutic, and outcome features of post-COVID MG to better characterize this emerging nosological entity.

Literature Review: Reported cases of MG occurring after COVID-19 describe both localized and generalized forms, typically appearing within weeks after infection. Autoimmune testing frequently reveals antibodies against acetylcholine receptors (anti-AChR), suggesting a virus-triggered or virus-amplified autoimmune mechanism. Patients present with variable degrees of muscle fatigability, ptosis, diplopia, or generalized weakness, independent of the initial severity of COVID-19. Management follows standard MG treatment protocols, including cholinesterase inhibitors, immunotherapy, and, in selected cases, thymectomy, with generally favorable outcomes when diagnosis is timely and treatment is appropriate.

Conclusion: Post-COVID myasthenia appears to be an emerging clinical entity, potentially distinct in its demographic, immunological, and outcome characteristics. Early recognition of this syndrome is crucial for initiating appropriate therapy, particularly in patients experiencing persistent fatigue after SARS-CoV-2 infection. More studies are needed to elucidate underlying mechanisms and optimize management strategies.

Keywords: Myasthenia gravis, COVID-19, Post-COVID fatigue, Autoimmunity, Anti-AChR antibodies.

Efficacy, effectiveness, and safety of respiratory syncytial virus vaccines in adults: Evidence from clinical trials and real-world effectiveness studies

Chanokporn Puchongmart — 2026-07-07

Respiratory syncytial virus (RSV) is an important and under-recognized cause of acute respiratory infection in adults, with disproportionate morbidity and mortality among older adults and individuals with chronic cardiopulmonary diseases. Global and regional burden estimates demonstrate that RSV contributes substantially to hospitalizations and deaths, highlighting the need for effective prevention strategies. Following decades without licensed options for adults, several RSV vaccines have recently completed late-phase clinical trials and entered clinical use. This narrative review synthesizes data on RSV vaccine efficacy, real-world effectiveness, and safety in adults aged 60 years or older and clinically vulnerable populations, including those with chronic medical conditions and immunocompromised states. Across clinical trials, RSV vaccines consistently demonstrated meaningful efficacy against RSV-associated lower respiratory tract disease, with higher protection against severe disease and evidence of persistence across multiple RSV seasons, although attenuation over time was observed. Safety data from randomized trials showed increased reactogenicity without major serious adverse events, whereas post-licensure surveillance identified small excess risks of rare neurologic events. Overall, current RSV vaccines provide clinically important protection against severe RSV disease in older adults, with ongoing research needed to optimize use in high-risk populations.

Keywords: Respiratory syncytial virus, vaccine, vaccine efficacy, vaccine effectiveness, safety

The correlation between brain natriuretic peptide levels and six-minute walk distances in patients with heart failure with a preserved ejection fraction

Gaspar Del Rio-Pertuz — 2026-07-07

Patients with heart failure with preserved ejection fractions (HFpEF) often have complex presentations and have significant comorbidity. This diagnosis occurs more frequently in older women with hypertension, diabetes, and obesity. Their cardiac disorder and their comorbidity limit their physical activity levels. Management of these patients requires regular follow-up with adjustment of the medication, if needed. Trends in simple laboratory tests, such as a brain natriuretic peptide levels, could help determine responses to treatment and prognosis. This study analyzed the correlation between BNP levels and six-minute walk test distances in patients with established HFpEF. The study included 21 patients with a mean age of 61.1 ± 9.1 years. All patients had hypertension, 11 patients had diabetes, and 10 patients had chronic kidney disease. The mean BNP level was 490.0 ± 653.5 pg/mL. The mean six-minute walk distance was 300.4 meters ± 120.8 meters. There was no significant correlation between the six-minute walk distance and the BNP. Consequently, this study demonstrates that routine measurement of BNP levels does not provide significant information about the patient’s overall physical performance level.

Keywords: Heart failure with preserved ejection fraction, brain natriuretic peptide, six-minute walk distance

Atypical zoonotic peritoneal dialysis–related peritonitis

Varote Shotelersuk — 2026-07-07

Zoonotic organisms are an uncommon but increasingly recognized cause of peritoneal
dialysis (PD)-related peritonitis, particularly among patients with close exposure to animals.
We report the case of a young male end-stage renal disease on PD and newly diagnosed
liver cirrhosis who developed refractory PD-related peritonitis caused by the rare zoonotic
pathogens Pasteurella dagmatis and Neisseria zoodegmatis following contamination of the
peritoneal dialysis equipment by cat saliva. Despite treatment with intraperitoneal and oral
antimicrobial therapy, as well as a PD catheter removal, the patient’s symptoms persisted
and relapsed, ultimately resolving only after a prolonged course of cefepime combined with
oral metronidazole. This case highlights the challenges associated with managing PD-related
peritonitis caused by rare zoonotic organisms, as well as the potential impact of host factors
such as cirrhosis on treatment response. It also emphasizes the importance of avoiding animal
exposure in patients undergoing peritoneal dialysis.
Keywords: Peritonitis, zoonotic infection, cirrhosis

Transfusion-related acute lung injury (TRALI) following intravenous immunoglobulin infusion in a patient with myasthenia gravis

Liz Thaliath — 2026-07-07

Transfusion-related acute lung injury (TRALI) is a rare but potentially life-threatening complication of blood product administration and has been infrequently associated with intravenous immunoglobulin (IVIG) therapy. This case report describes an 82-year-old male with myasthenia gravis who developed acute respiratory distress approximately 30 minutes after initiating high-dose IVIG. His clinical presentation included severe hypoxemia, hypotension, fever, and bilateral pulmonary infiltrates on chest imaging. Bedside ultrasound showed a collapsible inferior vena cava and normal cardiac function, supporting a non-cardiogenic etiology. The patient had no recent transfusions, pulmonary disease, or other acute lung injury risk factors. Infectious, allergic, and cardiogenic causes were excluded, and the diagnosis of TRALI was established based on established clinical criteria. The IVIG infusion was immediately stopped, and the patient required mechanical ventilation. Plasmapheresis was initiated for the underlying myasthenic crisis, and the patient showed rapid clinical improvement, with successful extubation after the second session and discharge on immunosuppressive therapy. This case underscores TRALI as a rare but serious adverse event following IVIG administration. Timely recognition using clinical and imaging criteria, along with prompt supportive care, is essential. Greater awareness is needed to improve diagnosis and reporting of this underrecognized complication, particularly in neurologic patients receiving high-dose IVIG.

Keywords: TRALI, IVIG, myasthenia gravis

Systemic lupus erythematosus complicated by heart failure: A case series

Nattanicha Chaisrimaneepan — 2026-07-07

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with diverse cardiovascular manifestations, among which heart failure (HF) remains underrecognized. Although diastolic dysfunction is more common, systolic dysfunction due to lupus myocarditis or medication-related cardiotoxicity can lead to significant morbidity and mortality. We describe three young female patients with SLE who developed reduced ejection fraction (EF) and global hypokinesia, likely secondary to myocarditis. Clinical presentations ranged from mild symptoms to severe decompensated HF, with variable laboratory evidence of inflammation and disease activity.

Overall, two patients had improvement in cardiac function following immunosuppressive therapy and guideline-directed HF management, while one had a progressive clinical decline and died despite treatment. These findings highlight the heterogeneity in presentation, disease activity, and outcomes of SLE-associated cardiomyopathy. Lupus myocarditis, though uncommon, should be suspected in SLE patients presenting with new-onset HF, particularly in the absence of ischemic disease. Diagnosis is typically clinical, supported by biomarkers and imaging, as endomyocardial biopsy is rarely performed. Early recognition and a multidisciplinary approach targeting both HF and underlying autoimmune activity are essential to improve outcomes.

Keywords: Systemic lupus erythematosus, heart failure, myocarditis

The use of robotic bronchoscopy with EBUS and pulsed electric field ablation for metastatic melanoma in a lung nodule

Danielle Sanchez — 2026-07-07

Malignant melanoma is one of the lethal forms of cancer, with approximately 8,290 deaths
expected in 2024.1 Information available on melanomas of unknown primary origin remains
limited. A review by Song theorized that the most likely hypothesis of its etiology is immune
mediated regression of the primary after metastasis has occurred.3 Our case represents a patient
with metastatic melanoma found in both pancreatic and lung tissues. The pancreatic biopsy
results were consistent with malignant melanoma. Pancreatic melanoma is more commonly
a site of metastasis than a primary tumor, and in this case, the presentation was nonspecific.
Regardless, malignant melanoma is treated by immunomodulator therapy involving PD1
inhibitors alone or in combination with ipilimumab. That being said, the patient was considered
for a biopsy of the lung nodule with Pulsed Electric Field ablation as a concomitant treatment
approach by the oncology team.
After undergoing the biopsy but before starting treatment, the Pulse Electrical Field was used
for its properties of targeting the tumor site with its abscopal effect, leading to a process called
pyroptosis. Pyroptosis leads to inflammatory vesicles filled with damage-associated molecular
patterns (DAMPs), which are later released from the cell via gadermin D, GSDMD pores to elicit
an immune response.8 Treatment was successful at 8-month follow-up CT scan, which showed
no recurrence of the lesions. In summary, PEF leads to tumor shrinkage both within the targeted
treatment area and at distant sites outside the treatment field. This case is the first to use pulse
electrical field ablation as an adjunct to immunotherapy for malignant lesions.

Keywords: Endobronchial, melanoma, Pulse electrical field ablation, lung nodule, abscopal

A rare case of opportunistic Kluyvera bloodstream infection in a pediatric patient with supratentorial ependymoma

Moiz Khan — 2026-07-07

A 2.5-year-old girl with a history of surgically resected supratentorial ependymoma WHO grade 3 developed a central line-associated bloodstream infection (CLABSI) during hospitalization for intensity-modulated radiation therapy (IMRT). The patient had a peripherally inserted central catheter (PICC) line placed for management and developed fever five days post-insertion. Blood cultures from both PICC line and peripheral vein grew Kluyvera species, a rare gram-negative opportunistic pathogen from the Enterobacteriaceae family. The organism was susceptible to several antibiotics including piperacillin-tazobactam, carbapenems and aminoglycosides. The infected PICC line was removed, and the patient received systemic antibiotic therapy with piperacillin-tazobactam. Clinical improvement was observed within three days, with complete recovery from the infection achieved after five days of treatment. This case highlights the potential for Kluyvera spp. to cause CLABSI in immunocompromised pediatric oncology patients. It underscores the importance of prompt recognition, appropriate antibiotic therapy, and heightened surveillance and infection prevention strategies in this vulnerable population.

Keywords: Kluyvera species, Central line-associated bloodstream infection, Pediatric oncology, Ependymoma, PICC line, Opportunistic pathogen

Streptococcus pyogenesotitis media with ipsilateral hearing loss facial paralysis complicated by acute mastoiditis and petrous apicitis

Carter Chapman — 2026-07-07

Streptococcus pyogenes is a common Gram-positive coccus frequently encountered in clinical medicine as the causative agent of skin and soft tissue infections and pharyngotonsillitis. It is also a rare causative agent of acute otitis media, where it is more frequently associated with a complicated disease course when compared to typical causes of acute otitis media. We present a novel case of acute otitis media caused by S. pyogenes that was complicated by ipsilateral hearing loss, ipsilateral facial paralysis, acute mastoiditis, and petrous apicitis in a young adult woman with no significant past medical history.

Keywords: Streptococcus pyogenes, acute otitis media

Challenges in treating Staphylococcus epidermidis ventriculitis:The role of biofilm formation and antimicrobial resistance

Esteban Perez — 2026-07-07

Ventriculitis caused by Staphylococcus epidermidis presents significant management challenges due to biofilm formation and antimicrobial resistance, particularly in patients with external ventricular drains (EVDs). This case report highlights the complexities of treating S. epidermidis-associated ventriculitis and the role of combination antibiotic therapy in overcoming persistent infection.

A 54-year-old male with diabetes mellitus and hypertension presented with altered mental status and was diagnosed with a spontaneous hemorrhage in the left basal ganglia. An EVD was placed for intracranial pressure management, but the patient subsequently developed ventriculitis, confirmed by cerebrospinal fluid (CSF) cultures positive for S. epidermidis. Initial treatment with IV Vancomycin failed to eradicate the infection, prompting the addition of Rifampin, a strategy supported by literature on biofilm-associated infections. The patient’s clinical course was further complicated by a non-occlusive pulmonary embolism.

This case underscores the limitations of vancomycin monotherapy against biofilm-associated S. epidermidis infections and highlights the efficacy of Rifampin in achieving bacterial clearance. Notably, CSF cultures remained persistently positive until rifampin was introduced, leading to the first negative culture and eventual placement of a ventriculoperitoneal shunt. Coagulase-negative staphylococci, including S. epidermidis, account for 50-75% of central nervous system (CNS) shunt infections and typically elicit a less robust inflammatory response, complicating early diagnosis. Our findings emphasize the need for early recognition of biofilm formation and prompt initiation of targeted antimicrobial therapy to improve outcomes in CNS device-related infections. This case supports the use of combination antibiotic therapy and device management as critical components in treating biofilm-associated ventriculitis.

Keywords: Staphylococcus epidermidis, ventriculitis, biofilm, rifampin, antimicrobial resistance

Acute pancreatitis and diabetic ketoacidosis associated with compounded semaglutide

Napat Wongmat — 2026-07-07

This case describes a patient without a history of diabetes who, after three months of compounded semaglutide use, presented with acute pancreatitis complicated by diabetic ketoacidosis (DKA). The patient presented to the ED with nausea, vomiting and mild abdominal pain. She was found to be in high anion gap metabolic acidosis, hyperglycemic and with elevated lipase. The patient was treated for DKA, with resolution of her symptoms. She was ultimately discharged without insulin and advised to stop her semaglutide.

Keywords: Glucagon-Like Peptide 1, pancreatitis, Diabetic Ketoacidosis, hyperglycemia

Bilateral Todd’s paralysis after status epilepticus

Edwin Paul — 2026-07-07

Todd’s paralysis is a transient postictal neurologic deficit most often presenting as unilateral weakness that resolves within 48 hours. Bilateral involvement is exceedingly rare and can closely mimic acute spinal cord or neuromuscular pathology. This Clinician’s Corner case describes a young woman who developed acute bilateral lower-extremity weakness following status epilepticus, with complete spontaneous recovery within 32 hours. The case highlights key diagnostic features of bilateral Todd’s paralysis and emphasizes a practical, clinically oriented approach to evaluation and management.

Keywords: Todd’s paralysis, Status Epilepticus, Postictal paralysis, Epilepsy, Neurologic deficits

Restricted cubic splines

Shengping Yang — 2026-07-07