Dr. Angela M. McLean, M.D., FACP
One of My Toughest Cases
LSUHSC School of Medicine; Specialty: Internal Medicine
Photographed by Craig Mulcahy
It Wasn’t Asthma; So What Was It?
A New Orleans native, Dr. Angela McLean, M.D., F.A.C.P, practices internal medicine and serves as an associate professor of medicine at LSU School of Medicine. She said that one of her toughest cases happened when she consulted on the case of a patient who had arrived in the emergency room, presumably for severe asthma.
“He did not improve, despite optimal treatment,” she says. The patient’s symptoms included shortness of breath, coughing and wheezing; “he appeared as if he was having an asthma attack,” McLean said.
After steroid treatment, his symptoms worsened. Following blood work, medical staff noticed he had eosinophilia — an increase in eosinophils, which are disease-fighting white blood cells that often indicate a parasitic infection. He underwent further testing for his sputum (mixture of saliva and mucus) and his stool.
Ultimately, he was diagnosed with strongyloides, a parasitic infection that is caused by a nematode, or roundworm.
According to the CDC, strongyloides is classified as a “soil-transmitted helminth. This means that the primary mode of infection is through contact with soil that is contaminated with free-living larvae.” Experts recommend preventing it by wearing shoes when one is walking on soil, and to avoid contact with fecal matter or sewage.
While the majority of people infected with it experience no symptoms, it can be life-threatening in others with compromised immune systems or other medical conditions.
Diagnosing this patient, Dr. McLean said, “reinforced the basics we all learn in training importance of a thorough history, particularly travel history.” Close examination of lab values, she says, can “always help solve a puzzle.”
The patient was treated with an antihelmintic (anti-parasite medication), and ultimately, he responded well to the treatment, she said.
Dr. McLean noted that in addition to treating her patients, she enjoys getting to know them and their families; seeing them improve and “most of all, training the physicians of the future,” she said. “I get to reinforce the importance of empathy for others, and why it is an honor and a privilege to care for patients.”
Undergraduate: Xavier University of Louisiana
Medical School: University of California San Francisco
23 years of practice