Browsing by Author "Wu, Joey"

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    Avascular Necrosis of the Hip with Truvada
    (2021-01-23) Wu, Joey; Henry, Arnold
    Background and Introduction Tenofovir disoproxil fumarate (Truvada) is a common HIV Pre-exposure prophylaxis regimen. Rare side effects such as renal toxicity, bone mineral loss have been reported but well documented relationship between Truvada use and AVN has not been well reported. The patient reported in this case study has no additional risk factor or underlying conditions that predisposes him to AVN of the hip aside from Truvada use. Case presentation 37-year-old gay male who is HIV negative in a monogamous relationship with a male of undetectable HIV viral load on Truvada prophylaxis with goal of decreasing HIV transmission risk. He began taking Truvada in Jan of 2015 and was without complications until Apr 2018 when he presented with left hip/quadricep pain initially diagnosed with IT band syndrome. He failed to improve with multiple courses of physical therapy and pain has been recurrent. He received X-ray of pelvis, bilateral hips, and lumbar spine with 4 views in Jun 2019. Result was significant for avascular necrosis of the left hip. He has no other comorbidities and began taking NSAIDs for pain control. His Truvada was discontinued Jun 2019 and pt began Descovy (Tenofovir alafenamide fumarate) but his ROC visit/imaging in Aug 2020 shows worsening AVN and symptomatic pain. Physical exam also shows significant atrophy of left lower extremity muscle groups and antalgic gait. Conclusion Truvada has been associated with AVN in patients without previous health risks for decreased bone health/density. Previous research have identified improved bone mineral density with discontinuing Truvada and beginning Descovy. However, this patient fails to improve with Descovy and continues to have worsening AVN, perhaps suggesting AVN is not associated with bone mineral loss but possibly other occult reasons.
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    A Case of Aceruloplasminemia Which Was Not Wilson Disease
    (2021-03-26) Williams, Cody; Clemens, Joseph; Wu, Joey; Zimmerman, Michelle
    Case: A 58 year old woman presented with 5+ years of fatigue and joint pain as well as recent short term memory concerns. She was evaluated for Lyme disease and was found to have mild anemia with elevated iron and persistently elevated ferritin as high as 2100 ng/ml. An unrelated cardiac scan had the incidental finding of hepatic iron accumulation. No fibrosis was noted on MRI. Liver biopsy was significant for 3-4+ hemochromatosis with sinusoidal dilation and congestion. Labs showed aceruloplasminemia with low urine and serum copper. Eye exam was negative for Kayser Fleischer rings but did show retinal iron deposits and early macular degeneration not supporting Wilson disease. Later genetic testing for CP (ceruloplasmin) gene showed heterozygosity for sequence variant c.2342A>C, predicted to cause amino acid substitution p.Lys781Thr. Conclusion: She is currently awaiting MRI to evaluate possible CNS disease in the setting of aceruloplasminemia but was delayed due to significant COVID-19 risk. Otherwise, she is tolerating deferasirox well. Significance: Our patient had a complex path to diagnosis given that low ceruloplasmin is commonly associated with Wilson disease. However, ceruloplasmin is also a key component in regulating ferric iron binding to transferrin and maintaining copper and iron homeostasis. This case was an exemplar of interdisciplinary diagnosis. Clinical evidence of anemia, ophthalmologic findings, and subjective cognitive dysfunction combined with histology and genetic results contributed to accurate characterization of aceruloplasminemia related hemochromatosis rather than Wilson’s disease. Genetic analysis revealed CP gene c.2342A>C (p.Lys781Thr), a novel mutation not reported elsewhere to our knowledge. Given her heterozygous status for the mutation, further investigation is needed. More importantly for our patient, recognition and treatment at this stage could reduce morbidity from neurodegeneration, pancreatic, and hepatic disease.
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    Predictors of Quality of Life after Liver Transplant
    (2020-11-14) Wu, Joey; Desai, Archita
    Background and Hypothesis: The impact of chronic liver diseases on patients and their family member is often understated and understudied. Chronic liver diseases can sometimes progress to a need for Liver transplant (LT). While recent studies have described quality of life (QOL) at different stages of liver disease, the impact of the patient’s QOL in LT survivors has not been examined. The importance of studying QOL in patients is due to its effect on the survivorship of LT recipients. We hypothesize that QOL in LT patients is lower than the general population. Our aim was to describe predictors of QOL in a well-described cohort of LT patients. Methods:Patients were enrolled at the Digestive and Liver Disease Liver clinic at Indiana University Hospital. All patients over the age of 18 were approached, if patients consented to the study, they were then enrolled during their liver follow up visit. The PROMIS survey was administered on an iPad and completed during the clinic visit. Survey were then scored and analyzed.Results: The T-scores for post liver transplant patients are lower in physical function, anxiety and depression, but higher in general life satisfaction compared to the general population. LT recipients have similar T-scores in Fatigue, Sleep disturbance, ability to participate in social activities, and pain interference compared to the general population. Conclusion and Potential Impact: Previous diagnosis of PBC, HCC, diagnosis of depression, household income, insurance status, Charlson Comorbid Index and number of non-transplant related medications have the highest association with quality of life. Further enrollment is needed to increase the power of the study. However, this can inform physicians the importance to taking these factors in to consideration in order to improve the QOL in LT recipients.