significance of a rarely pathogenic microorganism. Shewanella algae should be considered as an emerging pathogen in the setting of soft tissue
wounds or chronic ulcers. Appropriate treatment and source control in the setting of bacteremia is critical to recovery of severely septic patients.
AN UNUSUAL CASE OF PROFOUND HYPOTHYROIDISM LEADING TO RHABDOMYOLYSIS IN CHRONIC KIDNEY DISEASE. Maitri Acharekar, Roopitha Kaval; Baton Rouge General Hospital, Baton Rouge, LA.
Introduction: Hypothyroidism can manifest as myalgia, weakness, stiffness and mildly elevated muscle enzymes. However, rhabdomyolysis caused by hypothyroidism is extremely rare, especially without any precipitating conditions, such as intense activity, alcohol, or culprit medications. Management of rhabdomyolysis is further complicated in patients with underlying chronic kidney disease (CKD). Case: A 75-year-old female with hypothyroidism, CKD stage IV with baseline creatinine of 2.0, presented after her cardiologist notified her about severely elevated creatinine levels. Upon further inquiry, the patient complained of generalized weakness for the past three weeks and shortness of breath for two days. She did not take her synthroid for a month as she ran out of refills. The daughter at bedside also mentioned the patient has been confused lately. She also endorsed worsening bilateral lower extremity swelling and pain. On arrival, she had stable vitals although on exam she was drowsy with delayed cognition. She had a feeble pulse, bilateral wheezing on auscultation, distended abdomen, dry skin and absence of the lateral third of her eyebrows. Additionally, she had nonpitting edema over both shins. Lab work was
impressive for creatinine of 17.60 mg/dL, TSH of 349 uIU/mL and T4 of 0.42 ng/dL. She had a creatinine kinase (CK) level of >200000 U/L. Diagnosis of profound hypothyroidism induced rhabdomyolysis was established. The patient was initiated on intravenous hydrocortisone and synthroid and aggressive intravenous hydration. Despite aggressive hydration, the patient’s CK levels and creatinine did not improve and eventually required hemodialysis. Following dialysis, the patient showed rapid improvement in her symptoms as well as TSH, T4 and CK. She recovered well although she was eventually hemodialysis dependent given her underlying CKD. Discussion: Hypothyroidism is characterized by a wide range of symptoms, none of which are specific to the condition. Diagnosis typically relies on TSH and T4 measurements. In profound hypothyroidism, there is skeletal muscle breakdown causing rhabdomyolysis and elevated CK levels. The primary treatment for rhabdomyolysis is aggressive fluid hydration, but those with underlying CKD might need hemodialysis. Our case highlights the rare clinical manifestation of hypothyroidism-associated rhabdomyolysis; a high level of suspicion is required to diagnose it promptly.
AORTIC STENOSIS: A RISK FACTOR FOR PSEUDOMEMBRANOUS COLITIS. Kaleb Robin, Hannah Bunch, Guido DeJesus; Louisiana State University, Baton Rouge, LA.
Introduction: Pseudomembranous colitis is commonly associated with Clostridioides difficile infection (CDI). Pseudomembranes, the product of initial mucosal damage with subsequent neutrophilic infiltration, can less commonly be caused by noninfectious etiologies such as colonic ischemia. Here we present a rare case of pseudomembranous colitis from colonic ischemia due to newly found critical aortic stenosis.
Case: A 74-year-old female with diabetes mellitus and hypertension presented with presyncope, multiple episodes of non-bloody emesis, diarrhea, and severe abdominal pain after suspected food toxin ingestion. The patient was admitted to the intensive care unit for shock and required intravascular volume resuscitation as well as vasoactive therapy with norepinephrine. Abdominal computed tomography showed moderate wall thickening of the distal 25
Made with FlippingBook Digital Publishing Software