United States

Background: Pseudomonas aeruginosa continues to be a significant opportunistic pathogen, with growing antibiotic resistance and no available vaccine. Previous work showed that the P. aeruginosa type III secretion system (T3SS) protein, PopB, elicits a protective Th17 response after intranasal immunization using the Th17 adjuvant curdlan, but the protection is of low potency. In those studies, PopB was co-purified with its chaperone PcrH. In the current studies, we tested whether fusing or mixing PopB with PcrV, a T3SS protein known to elicit protective antibodies, would enhance protective efficacy. We also hypothesized that adding a Th17 antigen (PopB) to PcrV would improve mucosal IgA responses to PcrV.


Methods: Fusion proteins to the avidin homolog rhizavidin (Rhavi) were constructed to achieve multimeric antigen presentation as dimers and also for future coupling to biotinylated polysaccharides. A fusion protein of Rhavi to full-length PcrV and PopB (denoted RVB) was purified from E. coli using a pACYCDuet-1 vector co-expressing His-PcrH, where untagged RVB bound to His-PcrH was pulled down by nickel affinity resin, followed by ion exchange chromatography and then negative affinity chromatography with nickel resin using elution with 0.1% LDAO to dissociate RVB from His-PcrH. Recombinant His-tagged Rhavi-PcrV, PcrV, and PopB/PcrH were prepared by published methods. Mice were immunized intranasally using curdlan as adjuvant. IgA titers in bronchoalveolar lavage fluid (BALF) were assayed by ELISA, and Th17 responses were assessed by measuring IL-17 (ELISA) in supernatants of splenocytes stimulated with antigens in vitro. Protective efficacy was evaluated in a murine acute pneumonia model using P. aeruginosa strain N13.


Results: Our results show significantly higher IgA titers to PcrV in BALF of mice immunized with RVB when compared to mice immunized with either PcrV or Rhavi-PcrV, where IgA titers were undetectable. Th17 responses to PopB were significantly higher in RVB-immunized mice compared to mice immunized with PopB/PcrH. In the P. aeruginosa acute pneumonia model, RVB-immunized mice displayed 100% survival, whereas PcrV- and Rhavi-PcrV-immunized mice had approximately 60% survival (logrank P=0.06 compared to RVB), all significantly higher than curdlan-immunized mice (0% survival).


Conclusion: These results suggest that integrating PopB with PcrV into the same rhizavidin fusion protein elicits improved IgA titers to PcrV while maintaining a robust Th17 response to PopB, ultimately conferring broad and potent protection against P. aeruginosa lung infection.

AMA Research Challenge 2025 

Pseudomonas aeruginosa Fusion Protein Vaccines Containing the Th17-stimulating Antigen PopB Improve Mucosal IgA Responses and Protective Efficacy in Mice After Intranasal Immunization

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Background: Crohn’s disease and ulcerative colitis are the two primary forms of inflammatory bowel disease (IBD) which are chronic autoimmune conditions that require timely diagnosis and appropriate lifelong management to prevent severe complications and preserve quality of life. Social Determinants of Health (SDOH), including economic stability, healthcare access, and social context, are known to impact chronic disease outcomes, yet their role in IBD remains underexplored. 

Methods: Existing studies on the relationship between SDOH and IBD often lack secondary layers of analysis, limiting deeper exploration of the structural or systemic drivers behind disparities in access. To build on this gap, we conducted a cross-sectional analysis using All-Payer Claims Databases (APCD) from the state of New York and the nationally representative Medical Expenditure Panel Survey (MEPS). APCD data was analyzed to assess associations between race, ethnicity, and hospital utilization metrics. MEPS analysis focused on SDOH impacting emergency room usage among IBD patients. We constructed a composite binary variable—“Underserved”—flagging individuals with one or more indicators of structural disadvantage.

Results: Analysis revealed that race had a modest but significant effect on length of stay (p = 0.044), with illness severity exerting a stronger influence (p < 0.001). Race and insurance type both significantly impacted total charges (p < 0.001), while ethnicity was associated with higher emergency and lower elective admissions (p < 0.001), though not with length of stay or cost. In the MEPS dataset, the composite Underserved variable was a statistically significant predictor of ER utilization among IBD patients. Individual components were not significant when entered together into multivariable models, likely due to multicollinearity. These findings suggest that cumulative social disadvantage is more predictive of healthcare access disparities than any single factor alone.

Conclusion: Economic stability and healthcare access emerged as the most influential and frequently co-occurring SDOH domains, particularly in relation to insurance and financial barriers. However, social and cultural drivers remain under examined in the current literature. Our results underscore the need for multidimensional analyses that reflect the compounding effects of disadvantage. Future directions include a geospatial analysis of IBD care access in marginalized populations and development of a public-facing, searchable disparities database to support patient and policymaker decision-making.


Social Determinants of Health and Adverse Outcomes in Inflammatory Bowel Disease

Background
Small vasculature, venous obstruction, or congenital anomalies can preclude transvenous access to the heart, often resulting in open chest surgery to implant cardiac therapy leads for pacing, defibrillation, or cardiac resynchronization. A minimally invasive approach under direct visualization to deliver pacing leads to the pericardium could reduce tissue damage, minimize pain, shorten recovery time, and obviate the need for fluoroscopy.

Methods
A single-use, low-cost pericardial access port was designed based on clinical requirements. The device includes collapsible flange for atraumatic insertion and crossed working channels to provide an optimal view of the surgical field under direct visualization.

Results
Finite element analysis and mechanical testing demonstrates that the tensile strength of its components is sufficient for use under clinical working conditions, with minimal risk of fracture. Prior animal work and a physician preliminary validation study suggest that PeriPath functions effectively for minimally invasive lead implantation procedures.

Conclusion
The mechanical design of the thoracic access port aids in safe placement of conductive leads to the pericardium. This device may obviate the need for open chest surgery, which may result in decreased incision length, associated pain, risk of infection, and length of hospital stay. The access port is also compatible with common lead implantation tools and may be readily adopted by interventional cardiologists and electrophysiologists, allowing for widespread implementation.

Design of a Thoracic Access Port for Pericardial Access and Pacemaker Implantation

Background
Feminine hygiene wipes are widely marketed for intimate care, yet few are evaluated for safety on vulvar skin. The American Academy of Dermatology (AAD) and the American College of Obstetricians and Gynecologists (ACOG) advise avoiding ingredients such as fragrance, parabens, phthalates, methylisothiazolinone (MI), botanical sensitizers, and certain surfactants, which are known to cause irritation, allergic contact dermatitis, or endocrine disruption. This study evaluates the dermatologic safety of commonly available feminine wipes in the U.S. using ingredient-level analysis based on AAD and ACOG guidance.

Methods
We identified 79 feminine wipes sold at major U.S. retailers. Product labels were reviewed for full ingredient transparency. Each product was assessed for presence of medically flagged ingredients based on AAD/ACOG recommendations. These included fragrance, MI/MCI, parabens, PEGs, propylene glycol, formaldehyde releasers, botanical allergens (e.g., lavender, menthol), dyes, and surfactants like sodium laureth sulfate. Each flagged ingredient contributed one point to a cumulative violation score. Products were stratified by safety tier: Excellent (0), Acceptable (1-2), Questionable (3-4), or Poor (≥5).

Results
Only 11 of 79 products (14%) received an “Excellent” safety score. Fragrance was present in 76% of products, despite being a leading cause of vulvar allergic reactions. Other frequently flagged ingredients included propylene glycol (39%), PEG compounds (33%), and botanical sensitizers such as linalool and eugenol. Notably, many products labeled as “sensitive,” “natural,” or “pH-balanced” still contained multiple allergens or irritants. Nearly half (48%) of all wipes fell into the “Questionable” or “Poor” categories.

Conclusion
Most feminine wipes on the U.S. market contain ingredients that AAD and ACOG recommend avoiding on vulvar skin. Fragrance, preservatives, and plant-derived allergens remain common, even in wipes marketed for sensitive use. These findings highlight a disconnect between marketing claims and medical safety guidelines. Dermatologists and gynecologists should counsel patients accordingly and advocate for safer formulations and clearer labeling standards.

Dermatologic Safety of Feminine Wipes for Vulvar Use: An Ingredient-Based Review of U.S. Products

Background
Urinary and sexual dysfunction are underrepresented complications in spine surgery literature, despite their significant impact on postoperative quality of life among male patients. These outcomes are particularly relevant in lumbar procedures, where autonomic and somatic structures critical to erectile, ejaculatory, and excretory functions are at risk. Anterior instrumentation may disrupt the hypogastric plexus and sympathetic chains, while posterior operations pose injury to nerve roots. However, comparative data on genitourinary complications by surgical approach in men remains limited.

Methods
The TriNetX Research Network was queried to identify adult males who underwent two- to seven-level vertebral instrumentation between 2010 and 2023 for lumbar, lumbosacral, or thoracolumbar stenosis, spondylolisthesis, scoliosis, or radiculopathy. Patients were categorized by anterior or posterior surgical approach. Those with complex spinal pathology, preexisting urogenital disorders, or a history of the opposite approach were excluded. Propensity score matching adjusted for age, ethnicity, and relevant comorbidities. Postoperative outcomes were identified using diagnostic and procedural codes.

The primary outcome was a composite measure of urinary complications (pain, incontinence, retention, extravasation, anuria, oliguria, polyuria, urethral discharge, and other specified and unspecified urinary dysfunction). The secondary outcome was a composite measure of sexual complications (pain, erectile/ejaculatory dysfunction, decreased libido, and other specified and unspecified sexual dysfunction). All outcomes were assessed at one, three, six, nine, and twelve months postoperatively.

Results
A total of 11,164 patients met all initial inclusion criteria (7,763 posterior, 3,401 anterior); following 1:1 propensity score matching, each cohort included 3,397 patients with comparable baseline characteristics. Post-matching analysis revealed that posterior instrumentation was associated with significantly higher odds of urinary complications at one month (OR=2.259), three months (OR=1.727), six months (OR=1.374), nine months (OR=1.339), and twelve months (OR=1.333). No significant difference in sexual complications was observed at earlier intervals, however, anterior instrumentation patients exhibited higher odds at twelve months (OR=0.630) postoperatively.

Conclusion
In this large, multicenter retrospective analysis of adult males undergoing multilevel spinal instrumentation, surgical approach was associated with distinct patterns of genitourinary complications. Posterior instrumentation carried consistently higher odds of urinary dysfunction, suggesting increased vulnerability of nerve roots involved in micturition. Sexual outcomes were comparable between groups until twelve months, when anterior instrumentation was linked to increased complications, potentially reflecting delayed effects on regional autonomic pathways. These findings underscore the importance of surgical approach in influencing long-term functional outcomes and may inform preoperative counseling and risk stratification in male spine surgery patients.

Comparative Analysis of Urinary and Sexual Dysfunction in Men Following Anterior versus Posterior Lumbar Instrumentation

Background
Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is widely used to treat diabetic eye disease (DED), yet systemic VEGF suppression may impair peripheral wound healing. The association between anti-VEGF treatment and risk of diabetic foot ulcers (DFUs) and lower extremity amputations (LEAs) remains unclear. We seeked to evaluate the risk of DFUs and LEAs associated with intravitreal anti-VEGF injections (IVI) in patients with DED and to compare risks among ranibizumab, aflibercept, and bevacizumab.
Methods
We conducted a retrospective cohort study (April 2005 - April 2025) using a multicenter, population-based electronic health records network encompassing over 120 million individuals from 71 United States healthcare organizations. Adults (≥18 years) diagnosed with DED (diabetic retinopathy or diabetic macular edema) who received ≥3 IVI were compared to those who received ≤2 injections (control group) during the study period, since prior evidence demonstrated systemic suppression of plasma VEGF levels following three monthly intravitreal injections. The exposure was IVI (ranibizumab, aflibercept, or bevacizumab). Main outcome measures included incidence of any LEAs, above-ankle LEAs, and DFUs following incident DED diagnosis. Propensity score matching (1:1) was applied to balance baseline characteristics between groups. Cox proportional hazards analyses were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) in the full cohort and among high-risk subgroups with proliferative diabetic retinopathy (PDR), peripheral artery disease (PAD), end-stage renal disease (ESRD), or DFUs.
Results
Of 448,100 patients with DED, 35,269 received ≥3 injections and 412,831 received ≤2 injections. After matching, 34,070 patients remained in each group. IVI cohort was associated with increased risk of LEA (HR 1.54, 95% CI 1.38–1.72), above-ankle LEA (HR 1.31, 95% CI 1.08–1.59), and DFU (HR 1.36, 95% CI 1.30–1.42) compared with the control group. In high-risk subgroups, IVI was associated with increased risk of LEA in patients with PDR (HR 1.44, 95% CI 1.27-1.62), PAD (HR 1.35, 95% CI 1.12–1.56), ESRD (HR 2.06, 95% CI 1.28–3.31), and DFU (HR 1.46, 95% CI 1.22–1.75). Risks were similar across anti-VEGF agents.
Conclusion
IVI therapy for DED was associated with increased risk of LEA, particularly with comorbid PDR, PAD, ESRD, or DFUs. These findings highlight the importance of monitoring for limb complications in patients undergoing intravitreal anti-VEGF treatment.

Intravitreal Anti-VEGF Therapy and Risk of Limb Complications in Patients with
Diabetic Eye Disease

Title: Diagnostic and Therapeutic Benefits of POCUS in Assessing Musculoskeletal Pain in Primary Care Settings

Background: Traditionally, when patients present with musculoskeletal pain in primary care settings, they are prescribed analgesics and possibly an X-ray to diagnose and treat the pain. It is only if the pain persists that other measures are taken, such as further imaging and referrals to pain management. Point of care ultrasound (POCUS) is a cheap and effective diagnostic tool that is often used in the ER to diagnose musculoskeletal pain to efficiently treat patients in a timely manner. 

Aim (goal or objective): The goal is to examine the diagnostic and therapeutic benefits of POCUS in evaluating musculoskeletal pain within primary care settings, compared to traditional imaging or clinical-only approaches.

Methods/Intervention: We conducted a literature-based review from PubMed, analyzing current evidence from cross-sectional studies, reviews, and case series involving POCUS use for MSK conditions in general practice. We focused on outcomes including diagnostic accuracy, patient satisfaction, care efficiency, and therapeutic applications (i.e. guided injections). Key studies from both inpatient and outpatient settings were used to extrapolate potential benefits relevant to primary care.

Results: POCUS enhances both diagnostic accuracy and procedural precision in evaluating musculoskeletal pain through real-time static and dynamic assessments. It facilitates immediate interventions—such as aspirations and injections—reducing reliance on external imaging. Studies also describe a “POCUS Positive Care Effect,” where patients report greater satisfaction, trust, and understanding of their condition. In primary care, this dual benefit of clinical utility and socioemotional value supports POCUS as a powerful, patient-centered diagnostic tool.

Conclusions/Discussion: POCUS offers both clinical and therapeutic advantages in musculoskeletal pain management in primary care—enabling faster diagnosis, better targeted treatments, and improved patient satisfaction. Its real-time capabilities and socioemotional benefits position it as a valuable, patient-centered alternative to the delayed and fragmented approach of traditional care pathways.

Diagnostic and Therapeutic Benefits of POCUS in Assessing Musculoskeletal Pain in Primary Care Settings


Background
Hypokalemia periodic paralysis (HPP) presents with episodic flaccid muscle weakness due to severe hypokalemia, which can be hereditary ionchannelopathy or acquired via renal losses such as distal renal tubular acidosis (dRTA). dRTA stems from impaired H⁺ secretion in α-intercalated cells, causing metabolic acidosis, alkaline urine, and potassium wasting. Primary Sjögren’s syndrome (pSS) can rarely causes tubulointerstitial nephritis through autoantibody mediated, triggering dRTA, and in rare cases, dRTA-induced HPP may be the presenting feature, even before sicca symptom. Here in, we report a case of HPP as the first manifestation of primary Sjögren’s syndrome-associated dRTA in a previously undiagnosed patient

Case Presentation
A 40-year-old woman arrived at the emergency department with acute, painless limb weakness that rapidly progressed over 48 hours to near-quadriplegia. Examination revealed areflexia but intact sensation and autonomic function. He complained of mouth dryness and muscle twitching. She has no history of diuretic use, endocrine disorder, nephrolithiasis, or substance abuse.
Laboratory studies demonstrated severe hypokalemia (1.4 mEq/L), metabolic acidosis (pH 7.26, HCO₃⁻ 13 mEq/L), a normal anion gap, alkaline urine (pH 7.6), positive urinary anion gap, and renal potassium loss confirming distal (type 1) RTA. Autoimmune screening yielded high-titer anti Ro and anti La positivity and Schirmer’s test < 5 mm bilaterally, fulfilling ACR/EULAR criteria for pSS. Renal function, albumin, and proteinuria were within normal limits; ultrasound excluded structural kidney disease.
She was treated with intravenous potassium chloride and sodium bicarbonate to correct electrolyte and acid base imbalance. High dose methylprednisolone followed by prednisone taper and pilocarpine were initiated to address autoimmune activity and sicca symptoms. Limb strength improved within 48 hours, and six month follow up showed no relapse and normalized biochemical parameters. 
Discussion
This case illustrates autoimmune-mediated pSS inducing distal (type 1) RTA, via lymphocytic inflammation and impaired H⁺ ATPase or carbonic anhydrase activity resulting in metabolic acidosis, renal potassium wasting, and severe hypokalemia triggering hypokalemic periodic paralysis. Distal RTA, uncommon in adults, warrants thorough exclusion of alternative renal, glomerular, endocrine, or structural etiologies, as was systematically accomplished here. Although patients with pSS often exhibit sicca symptoms, renal involvement may precede these signs, making paralysis the initial manifestation. Recognition through combined urine pH, anion gap, and autoimmune serology enabled prompt correction with potassium, bicarbonate, corticosteroids, and pilocarpine. This reinforces the importance of considering pSS in women presenting with unexplained hypokalemic paralysis, even in the absence of overt extraglandular features







Primary Sjögren’s Syndrome Presenting with Hypokalaemia Periodic Paralysis and Distal Renal Tubular Acidosis: A Case Report

Background
Goblet cell adenocarcinomas (GCAs) are uncommon, distinctive tumors of the appendix, accounting for under 14% of all appendiceal neoplasms. Their incidence is about 0.05 per 100,000 people annually, with a median diagnostic age of around 59 years. GCAs exhibit “intermediate” aggressiveness between appendiceal neuroendocrine neoplasms and adenocarcinomas, featuring both neuroendocrine and epithelial characteristics. We describe a case of a 54-year-old woman who was diagnosed incidentally following an appendectomy for appendicitis.

Case Presentation
A 54-year-old woman with well-managed hypertension was referred to our service, following an appendectomy on 08/04/2022 for suspected appendicitis. Histopathology unexpectedly revealed a 3.5–4.5 cm, grade 2 goblet cell adenocarcinoma involving the proximal two-thirds of the appendix. There was
transmural, lymphovascular, and perineural involvement, and positive margins. She had experienced mild, intermittent rectal bleeding over the previous six months but was otherwise asymptomatic. To rule out synchronous lesions, a colonoscopy was done on 08/25/2022. It was limited to 30 cm due to colonic narrowing, showing internal hemorrhoids. A follow-up CT scan on 09/15/2022 confirmed no polyps,
masses, or metastases. Due to positive margins at the appendiceal base, a right hemicolectomy was performed on 10/03/2022. Pathology revealed residual goblet cell adenocarcinoma invading the cecal muscularis propria (pT4b), with 0/22 regional lymph nodes involved (pN0), and no distant metastases
(pMx). KRAS mutation and microsatellite instability testing were negative. Postoperative surveillance with CEA monitoring every three months remained within normal limits. Laboratory tests showed iron
deficiency and low vitamin B12, which were treated successfully with intravenous iron and oral vitamin B12 supplementation following a loading intramuscular injection. She continues to be in remission.

Discussion
Most appendiceal GCAs are diagnosed incidentally upon histopathological examination of appendectomy specimens. This case underlines the necessity of routine pathology for all removed appendices, as tumors
may present solely with luminal obstruction. In resource-limited settings, where histopathology is performed inconsistently, such diagnoses may be missed, highlighting the need for increased support from
healthcare bodies. For cases with deeper invasion or positive margins, a right hemicolectomy confers a survival advantage in stages II and III of the disease. However, early detection remains challenging, underscoring the need for continuity of care to identify recurrence or metastasis. In women, the risk of transcoelomic spread to the ovaries suggests a possible role for gynecologic surveillance. Systematic reviews and meta-analyses are needed to develop evidence-based surveillance guidelines. Molecularly targeted therapies should also be explored for patients who are not surgical candidates.

Unveiling the disguise behind Appendicitis: A Case Study of Appendiceal Goblet Cell Adenocarcinoma


Background:
Rheumatoid arthritis (RA) is a systemic autoimmune disease that primarily presents as inflammatory polyarthritis. Extra-articular manifestations, including pleural and pericardial effusions can occur years after onset. Symptomatic unilateral pleural effusions are seen in ~3–5% of RA patients, while pericardial involvement is much rarer.

Case Presentation:
74-year-old transgender female with hypertension, chronic hepatitis B, and renal cell carcinoma in remission presented with subacute progressive dyspnea and unintentional weight loss. She had been hospitalized two months prior for an exudative pericardial effusion with signs of early tamponade, managed with pericardial drainage.

Upon re-admission, she was hypoxic at 88% on RA which improved with 4L oxygen. Imaging revealed a new moderate left-sided pleural effusion and a small recurrent pericardial effusion. Thoracentesis confirmed exudative effusion per Light’s criteria: pleural-to-serum protein ratio of 0.6, LDH ratio of 1.63, and pleural LDH of 262 U/L (>2/3 upper limit of normal). Glucose was normal (87 mg/dL). CT chest showed a mildly enlarged perivascular mediastinal lymph node and a stable right middle
lobe nodule, with no interstitial lung disease.

Autoimmune workup revealed RF of 32 IU/mL (normal <14) and anti-CCP >250 U/mL (normal <20). Infectious studies, cytology, and AFP cultures from both fluid compartments were negative. The effusions were attributed to RA-associated serositis, despite the absence of joint symptoms.
Her course was complicated by worsening hypoxemia requiring temporary pigtail catheter placement. After stabilization, she was started on prednisone, with plans to initiate methotrexate outpatient. Biologic therapy was deferred due to the risk of hepatitis B reactivation. Now, stable on lefunominode without recurrent serositis.

Discussion:
Pleural effusions are a recognized extra-articular feature of RA, though typically asymptomatic and discovered incidentally. While RA is more prevalent in biological females, RA-related lung disease is more common in males (annual incidence: 0.34% in females vs. 1.54% in males) (1). These effusions are typically unilateral, exudative, and left-sided. However, this case was atypical due to the absence of classically low glucose (<60 mg/dL) and high LDH (>700 U/L). Pericardial effusions are less common, seen in 3.6% of females and 1.7% of males with RA (2). Elevated RF and anti-CCP are associated with increased risk of extra-articular complications. This patient’s initial RA presentation as serositis, without joint involvement, is exceedingly rare. Extra-articular RA can precede joint symptoms. This case highlights the need to consider RA in patients with unexplained exudative pleural or pericardial effusions, even in the absence of joint involvement.


Silent Seropositive RA: Exudative Pleural and Pericardial Effusions as Initial Presentation of Rheumatoid Arthritis​

Ring Enhancements and Ringing Alarms: A Rare Case of Neurocysticercosis 



Background 

Neurocysticercosis (NCC), caused by the larval form of Taenia solium, is a leading cause of acquired epilepsy worldwide, particularly in endemic regions such as South Asia and Latin America. In non-endemic areas, NCC is often underrecognized, especially in immigrants or travelers. Clinical manifestations vary depending on the number, location, and stage of the cysts, and may include seizures, focal neurological deficits, or neuropsychiatric symptoms. 


Case Presentation 

A 37-year-old South Asian male with a history of ulcerative colitis and hypothyroidism presented to the emergency department following a witnessed syncopal episode accompanied by convulsive activity. Two days prior, he experienced a transient, involuntary leftward neck deviation while driving, lasting approximately 10 seconds without associated symptoms. The following day, while eating, he experienced a similar urge, followed by upward eye deviation, loss of consciousness, and generalized tonic-clonic movements of the upper extremities. Post-ictal confusion was noted. Initial evaluation revealed stable vital signs, mild leukocytosis, and hypokalemia. A CT scan of the head showed two small calcific foci in the right frontal and temporal lobes with associated vasogenic edema. MRI of the brain revealed two ring-enhancing lesions with surrounding edema, consistent with neurocysticercosis. Upon further questioning, the patient reported recent ingestion of undercooked pork, a potential source of Taenia solium infection. He was discharged on albendazole, praziquantel, prednisone, and levetiracetam. However, he returned to the ED two weeks later with mood swings, depression, and aggression. Levetiracetam was subsequently replaced with zonisamide. 



Discussion 

Neurocysticercosis is considered rare in the United States, with an estimated incidence ranging from 0.2 to 0.6 cases per 100,000 people per year. This case highlights the importance of considering neurocysticercosis in patients presenting with new-onset seizures and relevant epidemiologic exposure. While the patient’s neuropsychiatric symptoms were most likely due to levetiracetam, such symptoms can also occur in neurocysticercosis. These may include depression, psychosis, visual hallucinations, mood disturbances, and behavioral changes such as aggression or irritability.

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