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Browsing by Author "Rao, Megana"
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Item A rare presentation of herpes simplex virus encephalitis occurring in a pediatric patient on dupilumab for atopic dermatitis(Wiley, 2022) Rao, Megana; Grove, Daniel; Haggstrom, Anita; Medicine, School of MedicineA 4‐year‐old female with a history of atopic dermatitis developed herpes simplex virus (HSV) encephalitis while being treated with dupilumab and concomitant topical steroids. There was no prior history of HSV infections or immunodeficiency. To our knowledge, this is the first case of HSV encephalitis in a patient receiving dupilumab.Item Circumscribed Palmar Hypokeratosis With Superimposed Actinic Keratosis(Springer Nature, 2023-01-30) Auckerman, Erica; Rao, Megana; Samiei, Azadeh; Bell, Marcia C.; Rahnama-Moghadam, Sahand; Dermatology, School of MedicineA man in his late 70s with a history of psoriasis and non-melanoma skin cancer presented with a progressive rash on his right thenar eminence. He first noticed it about one year ago. He denied any pruritus in the affected region but did note some overlying skin breakdown. He had used topical betamethasone and calcipotriene cream in the past with minimal improvement. Physical examination revealed a pink atrophic plaque with linear hyperkeratotic borders and central fissuring on the right thenar eminence extending into the first webspace. A shave biopsy revealed hypokeratosis with a rim of surrounding hyperkeratosis and associated parakeratosis, basal keratinocyte atypia, and lichenoid inflammation. These histopathological features were consistent with circumscribed palmar hypokeratosis and central actinic keratosis. Circumscribed palmar hypokeratosis is often considered a benign entity, but there have been reports suggesting an association with premalignancy. The decision was made to treat with 5-fluorouracil and calcipotriene cream twice daily for six weeks. At his two-month follow-up, he endorsed a robust reaction, which was further suggestive of premalignant change. He had a near-complete resolution of the rash. This case features circumscribed palmar hypokeratosis and suggests a novel treatment option for patients who develop concomitant actinic keratosis.Item Describing Hidradenitis Suppurativa Misinformation Diffusion Among Facebook Users: A Content Analysis(Matrix Medical Communications, 2023) Méndez, Alejandra; Rao, Megana; Rahnama-Moghadam, Sahand; Gomaa, Basma; Walsh-Buhi, Eric R.; Dermatology, School of MedicineItem Hyperphosphatemic Tumoral Calcinosis With Pemigatinib Use(Elsevier, 2022-07-16) Puar, Akshan; Donegan, Diane; Helft, Paul; Kuhar, Matthew; Webster, Jonathan; Rao, Megana; Econs, Michael; Medicine, School of MedicineBackground/objective: Pemigatinib, a fibroblast growth factor receptor (FGFR) 1-3 inhibitor, is a novel therapeutic approach for treating cholangiocarcinoma when an FGFR fusion or gene rearrangement is identified. Although the most reported side effect of pemigatinib is hyperphosphatemia, tumoral calcinosis with soft tissue calcifications is not widely recognized as a complication. We report a case of patient with hyperphosphatemic tumoral calcinosis on pemigatinib. Case report: A 59-year-old woman with progressive metastatic cholangiocarcinoma, despite receiving treatment with cisplatin and gemcitabine for 7 months, was found to have an FGFR2-BICC1 fusion in the tumor on next-generation sequencing. Pemigatinib was, therefore, initiated. Four months into the therapy, multiple subcutaneous nodules developed over the lower portion of her back, hips, and legs. Punch biopsies revealed deep dermal and subcutaneous calcifications. Investigations revealed elevated serum phosphorus (7.5 mg/dL), normal serum calcium (8.7 mg/dL), and elevated intact fibroblast growth factor-23 (FGF23, 1216 pg/mL; normal value <59 pg/mL) levels. Serum phosphorus levels improved with a low-phosphorus diet and sevelamer. Calcifications regressed with pemigatinib discontinuation. Discussion: Inhibition or deficiency of FGF-23 results in hyperphosphatemia and can lead to ectopic calcification. Pemigatinib, a potent inhibitor of FGFR-1-3, blocks the effect of FGF-23 leading to hyperphosphatemia and tumoral calcinosis as observed in our case. Treatment is aimed primarily at lowering serum phosphate levels through dietary restriction or phosphate binders; however, the regression of tumoral calcinosis can occur with pemigatinib cessation, as seen in this case. Conclusion: As the use of FGFR 1-3 inhibitors becomes more prevalent, we aim to raise attention to the potential side effects of tumoral calcinosis.Item Predictors of Disease Severity in Children at Riley Hospital with Multisystem Inflammatory Syndrome in Children (MIS-C)(2021-07-30) Collins, Angela J.; Rao, Megana; Khaitan, Alka K.; Bhumbra, Samina S.AUTHORS: Angela J. Collins, MPH, BS(1); Megana Rao, BS(1); Alka K. Khaitan, MD(2); Samina S. Bhumbra, MD(2) AFFILIATIONS: (1) Indiana University School of Medicine. (2) Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana. ABSTRACT: BACKGROUND & OBJECTIVE: Multisystem Inflammatory Syndrome in Children (MIS-C) is a novel condition temporally associated post-SARS-CoV-2-infection. The associated inflammation injures various organs (mainly cardiac and gastrointestinal) and can cause ventricular dysfunction and/or coronary aneurysms, potentially leading to death. This project assessed how lab trends may predict disease outcomes of MIS-C patients at Riley Hospital for Children (RHC). METHODS: Five lab values (intake procalcitonin, platelet count nadir, absolute lymphocyte count nadir, sodium nadir, troponin-I peak, CRP peak) were assessed as potential predictors of MIS-C severity. Patient demographics (age, sex, race, ethnicity), prior medical history (chronic conditions, obesity), and clinical presentation (days of fever prior to admission) were also assessed as potential predictors of MIS-C severity and lab peaks/nadirs. Indicators of MIS-C severity included PICU admission, length of hospital stay, left ventricular ejection fraction (EF), and abnormal coronary artery findings on echocardiogram. Chi-Square, ANOVA, linear regression, and logistic regression models were completed in SAS9.4 to assess for correlation (α=0.05). RESULTS: 66 MIS-C patients, aged 9 months to 18 years (mean=8.7 years), were admitted to RHC May 2020-April 2021. 61% were male (n=41). All patients presented with fever. Average length of stay at RHC was 5.9 days. 47% (n=31) were admitted directly to the PICU and 15% (n=10) were transferred to the PICU during their hospital course. Race predicted sodium nadir (p=0.0363), ethnicity predicted intake procalcitonin (p=0.0007), and obesity predicted CRP peak (p=0.0055). Age predicted abnormal EF (p=0.0206) and abnormal coronary outcome on echocardiogram (p=0.0365). Sex and obesity also predicted abnormal coronary outcome on echocardiogram (p=0.0182 and p=0.0478, respectively). Troponin-I peak predicted abnormal EF (p=0.0035) and CRP peak predicted days of hospital stay (p=0.0096). CONCLUSION & IMPACT: CRP peak is predictive of days of hospital stay and may inform hospital course. Analysis of additional lab values may reveal additional predictors of disease severity to inform clinical care.