Open up the pages of any good mystery book, and you'll find they usually have one thing in common: a twist.
For physicians, encountering challenging medical cases with patients presenting symptoms that defy conventional diagnosis can be akin to navigating the twists and turns of a mystery novel. Like a classic detective, they must engage in a process to unravel the clues to solve the case: review the patient's medical history, conduct physical examinations, and run diagnostic tests to confirm or rule out known conditions, among other steps.
As part of her rotation at ChristianaCare in Delaware, third-year Doctor of Osteopathic Medicine (DO) student Jillianne Santos (DO '25) had the opportunity to assist in a detective-like
process on a case with its own twist.
Santos' abstract outlining the details of the case recently earned her honors as winner of the Delaware Abstract Competition by the American College of Physicians (ACP). Just the second third-year student to win this award, Santos presented her work at the 2024 Delaware Chapter Annual Scientific Meeting on February 3, and at the National ACP Internal Medicine Conference, April 18-20, 2024, in Boston, Massachusetts.
Working under the direction and guidance of ChristianaCare Internal Medicine resident Vincent Mack, DO, with support and oversight from ChristianaCare’s Nicholas Jennelly, MD, assistant chief of service, and others, the case Santos highlighted in her abstract had unique circumstances.
The male patient from Gambia initially presented with bone breakdown to the back of the neck. This could be the result of an infection, also known as cervical osteomyelitis, which is typically due to bacteria.
However, “Based on the patient’s presentation combined with the labs and imaging, a bacterial cause was less compelling and we were looking at either a cancerous picture or an atypical infection” Santos said.
With an extensive medical history to review, the team had their work cut out for them. “There were four to five different admissions [for this patient], hundreds of charts to pour over,” said Dr. Mack.
After multiple tests, scans and other diagnostic measures to discover the cause of the patient’s symptoms, the team got to the twist in the story: a fungus.
The fungus, called Scedosporium apiospermum, was likely introduced following a procedure to alleviate chronic ear infections
and is typically found in contaminated soil, water or manure. The patient in this
case was a chicken farmer.
Dr. Mack saw this as a unique learning opportunity for Santos. “She really stepped up,” he said. “She added her own spin on the case and her own details.”
“My hope for her is that she ends up wherever she wants to be, and I don't think she'll hit too many roadblocks with that given the type of person she is.”
For Santos, the appreciation for the team at ChristianaCare is mutual. “I'm so grateful to be at ChristianaCare,” she said. “The doctors I've worked with are so pleasant and supportive.”
Santos looks forward to continuing her rotations and pursuing a residency in Internal Medicine.
“It's the diagnostic conundrums we run into in medicine,” she said. “How can I put these puzzle pieces together to fit into one complete puzzle or diagnosis? It's just fascinating to me.”
Learn more about osteopathic medicine and PCOM's DO programs.
Explore additional PCOM student research projects.
For the past 125 years, Philadelphia College of Osteopathic Medicine (PCOM) has trained thousands of highly competent, caring physicians, health practitioners and behavioral scientists who practice a “whole person” approach to care—treating people, not just symptoms. PCOM, a private, not-for-profit accredited institution of higher education, operates three campuses (PCOM, PCOM Georgia and PCOM South Georgia) and offers doctoral degrees in clinical psychology, educational psychology, osteopathic medicine, pharmacy, physical therapy, and school psychology. The college also offers graduate degrees in applied behavior analysis, applied positive psychology, biomedical sciences, forensic medicine, medical laboratory science, mental health counseling, physician assistant studies, and school psychology. PCOM students learn the importance of health promotion, research, education and service to the community. Through its community-based Healthcare Centers, PCOM provides care to medically underserved populations. For more information, visit pcom.edu or call 215-871-6100.
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