University of Toledo Open Journal System

SettingsRadha Shah, Undergraduate student, Fall 2024 Neuropsychiatric Patient (NSCI 1000) student, College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615

Shah, Radha

Cover Art

Bailey, Brianna

Maag, Serena

Holt, Mathieu

Butt, Danyal

Iqbal, Ayman

Shrestha, Bibek

Willis, Davontae

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
 
https://dx.doi.org/10.46570/utjms-2025-1370   ©2025 UTJMS 
  
 
Acute Interstitial Nephritis Following Repeated 
Daptomycin Treatment for Recurrent Joint 
Infection: A Case of Delayed Identification of 
Infective Endocarditis 
Brianna Bailey1*, Serena Maag1, Mathieu Holt1, Danyal Butt2, Ayman Iqbal3, Bibek Shrestha3, Davontae 
Willis4 
1College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
2Internal Medicine Resident, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
3Neurology Resident, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
4Anesthesiology Resident, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
Email: brianna.bailey@rockets.utoledo.edu 
Received: 2024-08-08 
Accepted: 2024-09-16 
Published: 2025-06-30 
Introduction: Acute interstitial nephritis (AIN) is characterized by inflammation of the renal interstitium, 
often triggered by drug exposure. While vancomycin is commonly associated with AIN due to its known 
nephrotoxicity, other agents like daptomycin can also induce this condition, potentially leading to severe 
renal impairment.  
Case Presentation: A 68-year-old female with stage IIIA chronic kidney disease and hypertrophic 
obstructive cardiomyopathy, who had a dual-chamber implantable cardioverter-defibrillator (ICD) placed 
in March 2024, presented to the emergency department following her fourth joint infection drainage 
procedure in six months. Each infection, caused by Pseudomonas aeruginosa, was treated with repeated 
courses of daptomycin. During hospitalization, her renal function deteriorated, indicated by a significant 
increase in serum creatinine and BUN levels, leading to the need for hemodialysis, which continued after 
discharge. The ICD was identified as the source of recurrent infections and was promptly removed, but 
the patient remains on outpatient dialysis.  
Discussion: Although daptomycin is generally considered less nephrotoxic than vancomycin, it can still 
cause acute interstitial nephritis (AIN), particularly with repeated or prolonged use, which increases the 
risk of acute kidney injury (AKI). This case highlights the importance of vigilant renal function monitoring 
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
 
https://dx.doi.org/10.46570/utjms-2025-1370   ©2025 UTJMS 
  
 
in patients with chronic kidney disease who are undergoing multiple treatments with nephrotoxic agents 
to prevent severe outcomes, such as long-term dialysis. Clinicians must carefully weigh the benefits of 
daptomycin against its risks and remain alert for signs of AIN in patients presenting with unexplained 
renal impairment.  
Conclusion: Clinicians should maintain a high level of awareness regarding the potential side effects of 
medications, particularly when repeated courses are prescribed. Proactive monitoring of renal function 
and a thorough understanding of drug side effects are essential in preventing serious complications. 
Keywords: Daptomycin, Acute Interstitial Nephritis, Acute Kidney Injury, Pseudomonas, Infective 
Endocarditis, Joint Infection 
 


English

Acute Interstitial Nephritis Following Repeated Daptomycin Treatment for Recurrent Joint Infection: A Case of Delayed Identification of Infective Endocarditis

Alice Lu

Soutari, Shay

Mahasin A. Osman

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e1  
 
 
https://dx.doi.org/10.46570/utjms-2025-1382   ©2025 UTJMS 
  
 
Identification of a Novel Signaling Platform as a 
Cisplatin Target in Kidney Injury 
Alice Lu1, Shahd Soutari1, Mahasin A. Osman2* 
1 College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
2 Associate Professor, Division of Hematology and Oncology, Department of Medicine, 3000 Arlington Avenue, 
The University of Toledo, Toledo OH 43615 
Email: mahasin.osman@utoledo.edu 
Received: 2024-08-15 
Accepted: 2024-09-16 
Published: 2025-06-30 
Cisplatin is an effective standard of care chemotherapeutic agent used in the clinic for treating a wide 
range of human tumors. However, kidney injury is an adverse side effect of cisplatin therapy for which 
treatment is unavailable due to lack of mechanistic understanding of cisplatin action. While cisplatin 
interferes with DNA replication in highly proliferation tumor cells, it is unknown how it affects normal 
kidney cells. Our cell biological analyses in cultured cells and animal models largely supported our novel 
hypothesis that cisplatin targets adhesion proteins in kidney epithelia, disrupts cell-cell contacts and 
ultimately leads to kidney damage. Here, we provide further supportive evidence from bioinformatics 
analyses, using the Nephroseq platform. Our RNAseq data analyses identified a distinct signal 
transduction and structural pathway composed of a receptor tyrosine kinase, a scaffold signal modulator 
and a group of cell adhesion proteins. Together, these proteins form a signaling platform that regulate 
secretion and ion transport across kidney tubules. These findings pave the way for devising targeted 
therapies for cisplatin-induced kidney damage while preserving its efficacy in oncology. 
Keywords: Chronic Kidney Disease, IQGAP1, Research 
 


Identification of a Novel Signaling Platform as a Cisplatin Target in Kidney Injury

Markho, Mario

Eby, Hunter

Vergis, John

Kopacz, Jonathan

Yu, Young Min

Hershey, Michael

Cartwright, Kayla

Markho, Morgan

Arnold, Chase

Knight, Connor

McCullumsmith, Robert

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
https://dx.doi.org/10.46570/utjms-2025-1393   ©2025 UTJMS 
  
 
Identification of Potential Therapeutic 
Perturbagens for CNS-Metastatic Retinoblastoma 
Using In Silico Analysis of RB1 Gene Signatures 
Mario Markho1*, Hunter Eby1, John Vergis1, Jonathan Kopacz1, Young Min Yu1, Michael Hershey1, Kayla 
Cartwright1, Morgan Markho2, Chase Arnold1, Connor Knight1, Robert McCullumsmith3 
1College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
2Student, 281 West Lane Avenue, The Ohio State University, Columbus OH 43210 
3Professor, Department Chair of Neurosciences and Psychiatry, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
Email: mario.markho@rockets.utoledo.edu 
Received: 2024-08-16 
Accepted: 2024-09-16 
Published: 2025-06-30 
Background: Germline retinoblastoma is a malignant retinal tumor, classically presenting bilaterally in 
infants with leukocoria, strabismus, and visual impairment due to an autosomal dominant RB1 mutation. 
Despite advances in intraocular treatments, effective drugs treating retinoblastoma metastasized to the 
central nervous system (CNS) remain limited (1).  
Objective: This in silico study aims to identify novel retinoblastoma perturbagens that may reverse the 
molecular effects of germline retinoblastoma with metastasis to the CNS. Methods The Kaleidoscope 
data exploration tool identified knockdown (KD) and overexpression (OE) iLINCS signatures for the RB1 
gene. KD signatures were processed through Sig2Lead to find drug candidates with significantly positive 
or negative concordance. Candidates with the most negative concordance with RB1 KD signatures were 
further evaluated for their ability to penetrate the blood-brain barrier (BBB).  
Results: Kaleidoscope identified 12 RB1 KD iLINCS signatures and one OE signature. Sig2Lead revealed 
three top candidates that consistently reversed all 12 KD signatures: galantamine (concordance = -
0.355), AZD-1775 (-0.343), and amuvatinib (-0.337). While carboplatin, vincristine, and etoposide are 
standard treatments, only vincristine (-0.333) and etoposide (-0.306) showed effectiveness in reversing 
KD signatures, with vincristine reversing four and etoposide reversing seven signatures.  
Conclusion: Carboplatin does cross the BBB, but it was not found to reverse any RB1 KD signatures (3). 
Meanwhile, vincristine and etoposide were effective in reversing KD signatures, but both have limited 
BBB permeability (4). The acetylcholine esterase inhibitor galantamine does cross the BBB and is 
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
https://dx.doi.org/10.46570/utjms-2025-1393   ©2025 UTJMS 
  
 
currently being investigated as a treatment of visual deficits in neurotrauma, making it a strong 
candidate for treatment of retinoblastoma with CNS involvement (5). Additionally, AZD-1775 can 
penetrate the CNS and is being studied as a treatment of p53-deficient tumors when combined with 
carboplatin (6-7). Future studies should investigate the efficacy of galantamine and AZD-1775 paired 
with carboplatin as potential therapeutic agents for CNS-metastatic retinoblastoma. 
Keywords: Retinoblastoma, Oncology, Metastatic Cancer, Pharmacotherapy, Potential Drugs, RB1, 
Genetics 
 
References 
1. Cancela, M. B., Zugbi, S., Winter, U., Martinez, A. L., Sampor, C., Sgroi, M., Francis, J. H., Garippa, R., 
Abramson, D. H., Chantada, G., & Schaiquevich, P. A decision process for drug discovery in retinoblastoma. 
Invest New Drugs, 2021. 39(2), 426-441. doi:10.1007/s10637-020-01030-0  
 
2. Kaliki, S., Shields, C. L., Shah, S. U., Eagle, R. C., Jr., Shields, J. A., & Leahey, A. Postenucleation adjuvant 
chemotherapy with vincristine, etoposide, and carboplatin for the treatment of high-risk retinoblastoma. Arch 
Ophthalmol, 2011. 129(11), 1422-1427. doi:10.1001/archophthalmol.2011.289  
 
3. Carpentier, A., Stupp, R., Sonabend, A. M., Dufour, H., Chinot, O., Mathon, B., Ducray, F., Guyotat, J., Baize, 
N., Menei, P., de Groot, J., Weinberg, J. S., Liu, B. P., Guemas, E., Desseaux, C., Schmitt, C., Bouchoux, G., 
Canney, M., & Idbaih, A. Repeated blood-brain barrier opening with a nine-emitter implantable ultrasound 
device in combination with carboplatin in recurrent glioblastoma: a phase I/II clinical trial. Nat Commun, 
2024. 15(1), 1650. doi:10.1038/s41467-024-45818-7  
 
4. Muldoon, L. L., Soussain, C., Jahnke, K., Johanson, C., Siegal, T., Smith, Q. R., Hall, W. A., Hynynen, K., Senter, 
P. D., Peereboom, D. M., & Neuwelt, E. A. Chemotherapy delivery issues in central nervous system 
malignancy: a reality check. J Clin Oncol, 2007. 25(16), 2295-2305. https://doi.org/10.1200/JCO.2006.09.9861  
 
5. Naguib, S., Bernardo-Colon, A., Cencer, C., Gandra, N., & Rex, T. S. Galantamine protects against synaptic, 
axonal, and vision deficits in experimental neurotrauma. Neurobiol Dis, 2020. 134:104695. 
doi:10.1016/j.nbd.2019.104695  
 
6. Mueller, S., Cooney, T., Yang, X., Pal, S., Ermoian, R., Gajjar, A., Liu, X., Prem, K., Minard, C. G., Reid, J. M., 
Nelson, M., Haas-Kogan, D., Fox, E., & Weigel, B. J. Wee1 kinase inhibitor adavosertib with radiation in newly 
diagnosed diffuse intrinsic pontine glioma: A Children's Oncology Group phase I consortium study. Neurooncol 
Adv, 2022. 4(1), vdac073. doi:10.1093/noajnl/vdac073  
 
7.  Leijen, S., van Geel, R. M., Sonke, G. S., de Jong, D., Rosenberg, E. H., Marchetti, S., Pluim, D., van 
     Werkhoven, E., Rose, S., Lee, M. A., Freshwater, T., Beijnen, J. H., & Schellens, J. H. Phase II Study of    
     WEE1 Inhibitor AZD1775 Plus Carboplatin in Patients With TP53-Mutated Ovarian Cancer Refractory 
     or Resistant to First-Line Therapy Within 3 Months. J Clin Oncol, 2016. 34(36), 4354-4361. 
     doi:10.1200/JCO.2016.67 


Identification of Potential Therapeutic Perturbagens for CNS-Metastatic Retinoblastoma Using In Silico Analysis of RB1 Gene Signatures

Salke, Mitchell

Ferdous, Tahrima

Altorok, Nezam

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
 
https://dx.doi.org/10.46570/utjms-2025-1407   ©2025 UTJMS 
  
 
Use of Avacopan as a Steroid-Sparing Medication 
in ANCA-associated Vasculitis Patients with 
Renal Impairment 
Mitchell Salke1*, Tahrima Ferdous1, Nezam Altorok2 
1Resident, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
2Professor, Program Director of Rheumatology and Director of Internal Medicine Residency, Division of 
Rheumatology, Department of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
Email: mitchell.salke@utoledo.edu 
Received: 2024-08-09 
Accepted: 2024-09-16 
Published: 2025-06-30 
Background: Alveolar hemorrhage can be a significant cause of mortality in patients hospitalized with 
ANCA-vasculitis and will often necessitate use of high-dose glucocorticoids early on in the hospital 
course. When considering a transition to steroid-sparing medications, options may be limited in patients 
with renal impairment. This case highlights the use of the C5a receptor inhibitor avacopan as an option 
in such patient populations.  
Case Presentation: A 69-year-old female with a history of CKD stage IIIA, insulin-dependent type 2 
diabetes mellitus, congestive heart failure, and hypertension was admitted to the hospital following a 1–
2-week history of fatigue and weakness after outpatient lab studies were significant for a hemoglobin of 
7.1. The initial chest x-ray showed only mild bibasilar opacities, but over the next couple of days, the 
patient began to experience worsening respiratory distress, ultimately requiring intubation. Due to 
significant fluid overload and worsening creatinine, the patient was started on hemodialysis. Bedside 
bronchoscopy showed erythematous mucosa of the bilateral bronchial trees with multiple foci or oozing 
blood concerning for alveolar hemorrhage. Rheumatologic work-up was significant for ANA at 1:1280 
with homogenous pattern, normal C3/C4, elevated MPO at 260 and PR3 at 36 with a positive p-ANCA. 
The patient was immediately started on high-dose IV glucocorticoids. When the time came to wean 
down steroids, cyclophosphamide was considered as an adjunct steroid-sparing therapy. However due to 
concerns for renal toxicity, a plan was made to start avacopan instead. Prior to initiation of avacopan, the 
patient’s family ultimately decided to pursue comfort measures.  
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
 
https://dx.doi.org/10.46570/utjms-2025-1407   ©2025 UTJMS 
  
 
Conclusion: Since alternative pathway complement activation has been shown to play a role in the 
pathophysiology of ANCA-associated vasculitis1, pharmaceuticals such as avacopan that inhibit this 
pathway may be considered as part of the treatment plan. This is especially true in patients with renal 
impairment, which is a common sequela of ANCA-associated vasculitis. 
Keywords: ANCA-Associated Vasculitis, Vasculities, Avacopan 
 
References 
1. Jayne, D. R., Merkel, P. A., Schall, T. J., Bekker, P. Avacopan for the treatment of ANCA-Associated 
vasculitis. New England Journal of Medicine, 2021. 384(7), 599–609. 
https://doi.org/10.1056/nejmoa2023386. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Use of Avacopan as a Steroid-Sparing Medication in ANCA-associated Vasculitis Patients with Renal Impairment

Alfatlawi, Halah

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium  UTJMS 2025 June, 13(S3):e1-e2
                      
 
10.46570/utjms-2025-1414    ©2025 UTJMS 
  
 
A Subtle case of Myxedema coma or 
decompensated hypothyroidism 
Tahrima Ferdous1*, Halah Alfatlawi1 
1Resident, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
Email: Tahrima.Ferdous@utoledo.edu 
Received: 2024-08-31 
Accepted: 2024-09-15 
Published: 2025-06-30 
Email: tahrima.ferdous@utoledo.edu  
Introduction: Decompensated hypothyroidism, formerly known as myxedema coma, is an endocrine 
emergency associated with profound thyroid dysfunction (1). The term “myxedema coma” is misnomer 
believing that they must either have edema or appear comatose to have this condition (2). It should be 
considered in patients who have altered mental status may include confusion, lethargy, stupor, or coma 
with bradycardia, hypotension, and/or hypothermia. The most common precipitating factor is infection 
such as pneumonia, urinary tract infections, and septicemia (3,4).      
Case Presentation:  A 53-year-old female with H/O total thyroidectomy who presented with history of 
dizziness, lethargy, generalized weakness, body aches, shortness of breath, chills, and urinary 
frequency.   Initial workup significant for Cr 1.37, eGFR 46, TSH 80, free T4 <0.25, CK 1091, total 
cholesterol 412, LDL 292, UA positive for moderate LE.  According to diagnostic scoring of myxedema 
coma (Popoveniuc G, ChaNdra T, Sud A, et al. Endocr Pract 2014; 11:1-36.) a score greater than 60 is 
highly suggestive of myxedema coma. Patient scored 75.   These include abdominal pain, precipitating 
factor UTI, bradycardia HR of 52, EKG changes, hypotension and decrease in GFR.   She received a dose of 
IV hydrocortisone 100 mg for hypotension, a dose of 400 mcg IV levothyroxine followed by 100 mcg and 
Keflex for UTI. She had significant clinical and biochemical improvement within 3 days of treatment. 
Probable causes of hypothyroidism such as medication noncompliance, incorrect pill technique, drug 
interactions and malabsorption were ruled out. She was discharged on 150 mcg of oral Tirosint daily.      
Conclusions:  Decompensated hypothyroidism is a dangerous condition with the potential for significant 
morbidity and mortality. Due to its similarities with other common conditions and subtle clinical 
manifestations severe hypothyroidism can be difficult to detect. Treatments should be given with adrenal 
and thyroid hormone supplementation and treatment of the inciting event without delays. 
Keywords: Endocrine, Hypothyroidism 
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium  UTJMS 2025 June, 13(S3):e1-e2
                      
 
10.46570/utjms-2025-1414    ©2025 UTJMS 
  
 
 
References 
1. Nicoloff John T. Thyroid Storm and Myxedema Coma. Medical Clinics of North America. 1985 Sep. 
69(5). doi:10.1016/s0025-7125(16)310021.  
2. Jordan, R.M. Myxedema coma. Pathophysiology, therapy, and factors affecting prognosis. Med Clin 
North Am, 1995. 79(1): pp. 185-194  
3. Rodríguez, E. Fluiters, L.F. Pérez-Méndez, R. Luna, C. Páramo, R.V. García- Mayor. Factors associated 
with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single 
institution. J Endocrinol, 2004.180(2):pp. 347-350.  
4. Yamamoto, T., Fukuyama, J., Fujiyoshi, A. Factors associated with mortality of myxedema coma: report 
of eight cases and literature survey. Thyroid, 1999. 9(12):pp. 1167-1174. 
5. Popoveniuc, G., Chandra, T., Sud, A., Sharma, M., Blackman, M.R., Burman, K.D., Mete, M., Desale, S., 
Wartofsky, L. A diagnostic scoring system for myxedema coma. Endocr Pract, 2014 Aug. 20(8):pp. 808-17. 
doi:10.4158/EP13460.OR 
 


A Subtle case of Myxedema coma or decompensated hypothyroidism

Abu-Rumaileh, Mohammed

Shah, Momin

Miller, Clare

Goyal, Rashmi

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance Dworkin Department of Medicine Research Symposium  UTJMS 2025 June 30, 13(S3):e1-e2 
 
 
https://dx.doi.org/ 10.46570/utjms-2025-1428   ©2025 UTJMS 
  
 
Recurrent COVID-19 induced Warm Autoimmune 
Hemolytic Anemia 
Mohammed Abu-Rumaileh1*, Momin Shah2, Tahrima Ferdous1, Clare Miller3, Rashmi Goyal4, Nezam Altorok5 
1Resident, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
2Fellow, Division of Rheumatology, Department of Medicine, 3000 Arlington Avenue, The University of Toledo, 
Toledo OH 43615 
3Resident, Department of Neurology, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
4Professor, Division of Rheumatology, Department of Medicine, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
5Professor, Program Director Rheumatology Fellowship, Director Internal Medicine Residency, Division of 
Rheumatology, Department of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
Email: Mohammed.Abu-Rumaileh@utoledo.edu 
Received: 2024-07-04 
Accepted: 2024-09-02 
Published: 2025-06-30 
Introduction: COVID-19 has revealed numerous complications, including hematologic issues such as 
Warm Autoimmune Hemolytic Anemia (WAIHA), where the immune system mistakenly attacks red blood 
cells. While COVID-19 is linked to the onset of WAIHA, this case presents a unique scenario for a patient 
experiencing recurrent COVID-19-induced WAIHA, with differing antibodies identified in each infection.  
Case Presentation: In April 2021, an 18-year-old female with sickle cell trait (Hgb A 58%, Hgb S 39%) 
presented with shortness of breath, jaundice, and severe anemia, with a hemoglobin level of 5.5 g/dL. 
Lab results showed a positive direct antiglobulin test (DAT) for complement but negative for IgG, 
consistent with a diagnosis of WAIHA. She was treated with Prednisone and Rituximab, resulting in an 
improvement of her hemoglobin to 7.0 g/dL before discharge, and subsequently to 11-13 g/dL after 
completing treatment. For the next 18 months, her hemoglobin remained stable between 13-13.9 g/dL 
without signs of hemolysis. In December 2023, she presented again with symptoms following a COVID-
19 infection, including severe anemia with a hemoglobin level dropping from 7.8 g/dL to 6.1 g/dL within 
hours. This time, her DAT was positive for IgG but negative for complement, a change from her previous 
episode. The patient required blood transfusion and was treated with IV Methylprednisolone, leading to 
an improvement in her hemoglobin. Unlike her first episode, Rituximab was not needed. Notably, the 
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance Dworkin Department of Medicine Research Symposium  UTJMS 2025 June 30, 13(S3):e1-e2 
 
 
https://dx.doi.org/ 10.46570/utjms-2025-1428   ©2025 UTJMS 
  
 
WAIHA in this patient occurred exclusively during COVID-19 infections, with different antibody profiles in 
each episode.  
Discussion: This case highlights the complex relationship between COVID-19 and WAIHA, where the virus 
appears to trigger autoimmune hemolysis. The shift in antibody profiles between episodes, with 
complement positivity in the first instance and IgG positivity in the second, suggests a dynamic immune 
response influenced by the viral infection. Understanding these variations is critical for managing these 
cases. 
Keywords: Covid-19, Warm AIHA, Hemolytic Anemia 
 
 


Recurrent COVID-19 induced Warm Autoimmune Hemolytic Anemia

Vijendra, Divya

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium  UTJMS 2025 June 30, 13(S3):e1-e2                     
 
 
https://dx.doi.org/10.46570/utjms-2025-1439   ©2025 UTJMS 
  
 
Medical Management of Pigmented Villonodular 
Synovitis of the Right Ankle and Foot 
Brianna Bailey1*, Divya Vijendra2 
1College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 
43615 
2Assistant Professor, Division of Hematology and Oncology, Department of Medicine,3000 Arlington 
Avenue, The University of Toledo, Toledo OH 43615 
Email: brianna.bailey@rockets.utoledo.edu 
Received: 2024-08-01 
Accepted: 2024-09-11 
Published: 2025-06-30 
Introduction: Pigmented Villonodular Synovitis (PVNS) is a rare, benign condition involving the 
overgrowth of synovial tissue, typically affecting the knee but also other joints like the hip and ankle. It 
causes joint pain, swelling, and reduced mobility, and can be either localized or diffuse. While the exact 
cause is unclear, it may involve inflammatory or neoplastic processes. Diagnosis relies on clinical 
symptoms, imaging (MRI), and histology. Though non-malignant, PVNS can be aggressive and cause joint 
damage if untreated. Treatment usually involves surgical resection or synovectomy, sometimes with 
radiotherapy to prevent recurrence.  
Case Presentation: A 66-year-old female with fibromyalgia and osteoporosis presented with right ankle 
pain and swelling. Radiographs in September 2023 showed severe degenerative changes in the tibiotalar 
and first MTP joints, with joint effusion and varus alignment. MRI in October 2023 confirmed advanced 
osteoarthritis and synovial thickening. After temporary relief from a cortisone injection, a core biopsy in 
July 2024 revealed Pigmented Villonodular Synovitis (PVNS). With no bacterial growth, the patient 
declined surgery and was referred to hematology/oncology for treatment with pexidartinib, a CSF-1 
inhibitor.  
Discussion: The management of Pigmented Villonodular Synovitis (PVNS) has evolved from relying solely 
on surgery to incorporating therapies that reduce recurrence and manage challenging cases. While 
surgical resection, either via arthroscopy or open synovectomy, remains the primary treatment, diffuse 
PVNS poses a higher risk of recurrence and joint damage. Recent advancements have introduced CSF1R 
inhibitors like pexidartinib, which target the disease’s molecular drivers, offering a non-surgical option 
for diffuse or refractory cases. Other therapies, such as radiation synovectomy, have also shown promise 
but carry potential risks. Ultimately, treatment should be individualized based on disease severity and 
patient health. 
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium  UTJMS 2025 June 30, 13(S3):e1-e2                     
 
 
https://dx.doi.org/10.46570/utjms-2025-1439   ©2025 UTJMS 
  
 
Keywords: Pigmented, Villonodular Synovitis, Pexidartinib, CSF1R Inhibitor, Synovium, Neoplastic, Non-
Malignant 
 
 


Medical Management of Pigmented Villonodular Synovitis of the Right Ankle and Foot

Tomac, Katarina

Campbell , Andrew

Askari , Mani

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2                       
 
 
https://dx.doi.org/10.46570/utjms-2025-1445   ©2025 UTJMS 
  
 
A Case of Skin Necrosis During Severe Sepsis 
Complicated by Disseminated Intravascular 
Coagulation 
Katarina Tomac1*, Andrew Campbell2, Mani K. Askari3 
1College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
2Hospitalist, University of Toledo Medical Center, 3000 Arlington Avenue, The University of Toledo, Toledo OH 
43615 
3Assistant Professor, Internal Medicine Clerkship Program Director, Division of Internal Medicine, Department 
of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
Email: ktomac@rockets.utoledo.edu 
Received: 2024-08-14 
Accepted: 2024-09-16 
Published: 2025-06-30 
Background: Purpura fulminans is a skin manifestation of a thrombotic microangiopathy known as 
diffuse intravascular coagulation (DIC) that occurs in severe infection. It is characterized by microvascular 
thrombi affecting the skin of the extremities, causing skin necrosis and threatening limbs or digits. 
Purpura fulminans is relatively uncommon, but the presence of these skin findings implies certain 
management strategies that can improve coagulopathy and possibly save a patient’s limb.   
Case Presentation: Here we present a case of a woman with severe sepsis who developed skin necrosis 
and distal ischemia while undergoing aggressive treatment in the medical ICU. Surgical debridement 
revealed non-bleeding skin, soft tissue and skin necrosis that spared the underlying fascia. The veins of 
the skin were thrombosed, and the skin culture was negative for infection. In the patient’s lab work, she 
had elevated INR, low fibrinogen, thrombocytopenia, and an elevated d-dimer level.  
Conclusion: Purpura fulminans is diagnosed based on characteristic skin findings in the setting of sepsis 
and coagulopathy. This finding has unique implications for management, affecting choices of 
vasopressor, anticoagulation, and blood products. Its pathophysiology is thought to be driven by 
consumption of protein C, crucial to preventing excessive thrombosis in maintaining homeostasis in the 
coagulation system. Conservative measures such as topical vasodilators may be used but commonly, 
patients require surgical debridement and supportive measures that resemble the care of burn victims. 
Awareness of this life-threatening form of thrombotic microangiopathy, and understanding its treatment 
implications, may decrease morbidity in patients with severe sepsis. 
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2                       
 
 
https://dx.doi.org/10.46570/utjms-2025-1445   ©2025 UTJMS 
  
 
Keywords: Purpura Fulminans, Necrosis, Disseminated Intravascular Coagulation, Internal Medicine 
 
References 
1. Perera, T.B., Murphy-Lavoie, H.M. Purpura Fulminans. In: StatPearls [Internet]. Treasure Island (FL): 
StatPearls Publishing; [Updated 2023 Jul 17]. 2024, Jan. Available from: 
https://www.ncbi.nlm.nih.gov/books/NBK532865/ 
2. EMCrit, A. Purpura Fulminans - EMCRIT Project. EMCrit Project, 2023, February 8. 
https://emcrit.org/ibcc/pf/#rapid_reference 
3. Robboy, S.J., Mihm, M.C., Colman, R.W., Minna, J.D. The skin in disseminated intravascular 
coagulation. Prospective analysis of thirty-six cases. Br J Dermatol. 1973 Mar; 88(3):221-9. 
Doi:10.1111/j.1365-2133.1973.tb07538.x 
4. Contou, D., Urbina, T., de Prost, N. Understanding purpura fulminans in adult patients. Intensive Care 
Med, 2022. 48(1), 106-110. https://doi.org/10.1007/s00134-021-06580-2 


A Case of Skin Necrosis During Severe Sepsis Complicated by Disseminated Intravascular Coagulation

Murthy, Nithara

Kelly, Victoria

Swaminathan , Manasa

The University of Toledo Translation Journal of Medical Sciences 
UTJMS 2025 October 15, 14(S1):e1-e2 doi:10.46570/utjms-2025-1480 
10.46570/utjms-2025-1480 ©2025 UTJMS 
Investigating the Symptom Profile of 
Depression and Validity of Psychological 
Assessments in the South Asian Population
Nithara Murthy1*, Victoria Kelly2, Manasa Swaminathan1 
1College of Medicine and Life Sciences,  3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
2Assistant Professor, Vice Chair for Education, General Psychiatry Residency Program Director, Department of 
Neurosciences and Psychiatry, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
Email: nithara.murthy@rockets.utoledo.edu 
Received: 12/2/2024 
Accepted: 12/18/2024 
Published: 10/15/2025 
Introduction: Despite South Asians accounting for ⅕ of the global mental health burden, culturally relevant 
research on how immigration and South Asian culture interact with depressive symptoms is lacking.7  
Objectives: This study aimed to explore differences in depression symptoms between native and immigrant 
South Asians in the U.S. and India, using the Beck Depression Inventory-II (BDI-II) and the Patient Health 
Questionnaire 9 (PHQ-9). It also assessed the reliability of BDI-II compared to PHQ-9, as BDI-II has not been 
proven to be culturally sensitive. 6,8 
Methods: Participants aged 18-24, of South Asian descent who had experienced depression, were recruited via 
social media and word of mouth. Sample size was 150, although 18 were excluded due to incomplete 
demographic criteria. The questionnaire included demographic measures, the BDI-II, PHQ-9, Collective Self-
Esteem Scale, and Perceived Discrimination Scale. Correlation analyses, survey logistics, and descriptive 
statistics were conducted using SAS software. 
Results: Both first and second-generation South Asian immigrants reported similar frequencies of somatic and 
psychological depressive symptoms, contradicting past research which indicated  predominantly somatic 
symptoms.3 Participants resonated strongly with work-related symptoms, such as concentration, fatigue, and 
self-critique, possibly due to the high emphasis on education in South Asian culture.2  Low identification with 
suicidality was noted, with only 48% reporting suicidal thoughts, possibly due to cultural values emphasizing 
mutual obligation and shame.5 Depressive symptom frequencies reported across BDI-II and PHQ-9 were 
similar, suggesting both tools have comparable accuracy in predicting depressive symptoms in this population. 
Conclusion: Resources should be focused on recognizing signs of depression in academic settings, and on 
educating community members on balancing cultural expectations and mental wellness. This study should be 
generalized only to South Asian immigrants from highly educated and high-income households, and should be 
repeated with a larger sample size in order to generalize.  
Keywords: Culture, Depression 
The University of Toledo Translation Journal of Medical Sciences 
UTJMS 2025 August 15, 14(S1):e1-e2 doi:10.46570/utjms-2025-1480 
10.46570/utjms-2025-1480 ©2025 UTJMS  
References 
1. American Psychological Association. APA 
Dictionary of Psychology. American Psychological 
Association, 2020. 
https://dictionary.apa.org/collective-self-esteem. 
 
2. Bhattacharya, G. The school 
adjustment of South Asian immigrant 
children in the United States. 
Adolescence, 2000. 35(137). 
 
3. Grover, S., Dutt, A., & Avasthi, A. 
An overview of Indian research in 
depression. Indian journal of 
psychiatry, 2010. 52(Suppl 1): pp. S178–S188. 
doi:10.4103/0019-5545.69231 
 
4. Karasz, A., Gany, F., Escobar, J., Flores, C., 
Prasad, L., Inman, A., Kalasapudi, V., Kosi, R., 
Murthy, M., Leng, J., & Diwan, S. Mental health 
and stress among South Asians. Journal of  
immigrant and minority health, 2019. 21: pp.7-14. 
 
5. Kramer, E. J., Kwong, K., Lee, E., & Chung, 
H. Cultural factors influencing 
the mental health of Asian Americans. 
The Western journal of medicine, 2002. 
176(4): pp. 227–231. 
 
6. Kroenke, K., Spitzer, R. L., & Williams, J. 
B. The PHQ‐9: validity of a 
brief depression severity measure. 
Journal of general internal medicine, 2001. 
16(9): pp. 606-613. 
 
7. Ogbo, Felix Akpojene, Sruthi Mathsyaraja,  
Rajeendra Kashyap Koti, Janette Perz, 
and Andrew Page. The burden of 
depressive disorders in South Asia, 
1990–2016: findings from the global 
burden of disease study. BMC 
Psychiatry, 2018. 18(1): pp. 1-11. 
 
8.Steer, R. A., Kumar, G., Ranieri, W. F., &   
Beck, A. T. Use of the Beck  
Depression Inventory‐II with adolescent  
psychiatric outpatients. Journal of  
Psychopathology and Behavioral Assessment, 
1998. 20(2): pp. 127-137. 
 
9.Williams, D. R., Yu, Y., Jackson, J. S., & 
Anderson, N. B. Racial differences in 
physical and mental health: Socio‐economic  
status, stress and discrimination. Journal of  
health psychology, 1997. 2(3): pp. 335-351. 


Investigating the Symptom Profile of Depression and Validity of Psychological Assessments in the South Asian Population

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