Teamwork Saves Woman with Rare Disorder

Charlotte Garrison celebrates her 70th birthday

In April 2017, Charlotte Garrison of South Bend, Indiana, was life-flighted to Cleveland Clinic, where she had emergency tracheostomy surgery to help her breathe. For close to a year before that, the 68-year-old woman had struggled with a rare immune disorder that caused sores in her nose and mouth. Now, they were suffocating her.

Charlotte’s symptoms first appeared in 2016, including severe fatigue that led the kindergarten teacher to early retirement. She was referred to Anthony Fernandez, MD, PhD (DMP’11), Director of Medical and Inpatient Dermatology at Cleveland Clinic, who specializes in treating autoimmune and inflammatory diseases affecting the skin.

At her first appointment in January 2017, he diagnosed the illness as mucous membrane pemphigoid, or cicatricial pemphigoid. “She has a relatively rare autoimmune blistering disease subtype,” he says. “For Charlotte, the trachea and airway mucosa were affected, and severe involvement of the airway can end up being life-threatening. In addition, the skin can be affected, and she had that, as well.”

This autoimmune disease causes scarring and permanent tissue damage. “When the upper airway is involved, this scarring can prevent air from getting to the lungs,” he says, “so we were very aggressive in starting medications.”

Dr. Anthony Fernandez

Dr. Matt Vasievich

Dr. Fernandez and Matt Vasievich, MD, PhD (D’17), then a medical resident, identified a cancer drug, rituximab, that could control her symptoms. Dr. Vasievich went to great lengths to obtain her insurance company’s approval. Still, there wasn’t time for the drug to take effect before Charlotte’s condition suddenly deteriorated, leading to a lifesaving tracheostomy by Paul Bryson, MD, Section Head of Laryngology in Cleveland Clinic’s Head & Neck Institute. This was followed by “a drug cocktail” to calm the inflammation and a few more operations to release scarring and treat the upper airway stenosis, Dr. Bryson says.

“I think that our experience, collaboration and aggressiveness in treatment were critical to Charlotte’s eventual recovery,” Dr. Fernandez says. “She is now doing fantastic.”

Dr. Fernandez and Dr. Vasievich credit their Cleveland Clinic training with helping them diagnose and treat patients like Charlotte.

“I could not be happier with my training here,” Dr. Fernandez says. “We have one of the best dermatopathology fellowships in the world. We’re an international referral center, so in training, we get as much breadth in the field as we will see in practicing. Both our dermatology and pathology clinics are outstanding. As a fellow, I could walk down the hall to consult internationally known experts who are editors of major textbooks. It is a very friendly and productive environment to practice in, which is why I wanted to stay.”

Dr. Fernandez’s duties include teaching and mentoring 12 dermatology residents and three dermatopathology fellows a year.

Dr. Vasievich, now on staff at an IHA medical dermatology clinic in southeast Michigan, says he is grateful for his years at Cleveland Clinic. “Someone once told me that when you get busy, you don’t rise to the occasion. You fall to the level of your training. I think about artists like Michelangelo, whose students went out and developed their own style but were influenced by their training. Dr. Fernandez is a fantastic medical dermatologist. You learn from great mentors like him. Now, after three years, I’m developing my own style as a physician.”