gastric parietal cells, causing a lack of intrinsic factor (IF) and impaired Vitamin B12 absorption. PA is marked by macrocytic anemia, Vitamin B12 deficiency, and IF antibodies. The co-occurrence of favism and PA causing severe hemolytic anemia has not been reported in the literature. Case: A 44-year-old male with diabetes, hypertension, and hyperlipidemia presented with 1.5 weeks of progressive fatigue, light-headedness, and shortness of breath. On arrival, the patient was normotensive, afebrile, but tachycardic. Physical examination revealed a diaphoretic male with mild jaundice and mucosal pallor. Laboratory tests showed hemoglobin decreased from 15 g/dL a year prior to 7.8 g/dL, an elevated MCV, low haptoglobin, elevated LDH, elevated direct and indirect bilirubin, and an elevated reticulocyte count. A peripheral blood smear indicated anisopoikilocytosis and schistocytes, consistent with severe hemolytic anemia, prompting a G6PD enzyme activity assay. Follow-up labs revealed normal folate and a vitamin
B12 level of 118 pg/mL. The patient was started on subcutaneous vitamin B12 supplementation, and an IF antibody assay was ordered. Pathology confirmed chronic antral gastritis. The patient received two units of packed red blood cells, resulting in improvement in symptoms and hemoglobin levels. The G6PD enzyme level returned as deficient and the patient reported a diet high in fava beans, coinciding with his symptoms. Additionally, the elevated IF autoantibody confirmed the diagnosis of PA. Discussion: While G6PD-deficient patients have an increased risk for autoimmune diseases, favism in a patient with concurrent PA has not been previously reported. Most G6PD patients are asymptomatic, but exposure to oxidative stressors—like certain medications, infections, or fava beans—can trigger hemolysis. The co-occurrence of macrocytic anemia from PA created a unique diagnostic and therapeutic challenge. This patient requires lifelong B12 supplementation, avoidance of oxidative stressors, and regular endoscopic screening for gastric cancer.
RECURRENT CHYLOTHORAX SECONDARY TO KAPOSI SARCOMA INFILTRATION OF THORACIC DUCT IN AIDS PATIENT. Gurtaj Mahil, Brandon Dang, Tamara Zaza, Victoria Lulich, Zachary Chandler, Kyle Happel, Shane Guillory; Louisiana State University, New Orleans, LA.
Introduction: Kaposi Sarcoma, associated with Human Herpes Virus-8 and HIV co-infection, often presents with cutaneous lesions but can involve the thoracic duct, causing a chylothorax. Disseminated Kaposi with direct infiltration of the thoracic duct is a rare but important cause of recurrent chylothorax in AIDS patients. Case: A 30-year-old male with HIV/AIDS and disseminated Kaposi Sarcoma presented with dyspnea, chest pain, cough, fever, and photophobia lasting one week. He had recently been hospitalized for bacteremia and right sided chylothorax, treated with two thoracenteses, removing 2.5 L of fluid. On this admission, physical exam revealed an ill- appearing patient with decreased breath sounds in the right lung, 2+ bilateral lower extremity edema, thoracic violaceous lesions, and a positive jolt test. Labs showed leukocytosis and hypoalbuminemia. A chest x-ray showed complete right hemithorax opacification, confirmed by a CT showing a large right
pleural effusion. Ultrasound-guided thoracentesis and chest tube placement drained 400cc of milky fluid, and pleural studies confirmed an exudative chylothorax with triglycerides of 403 mg/dL. A lumbar puncture ruled out meningitis. Despite chest tube placement, the patient’s symptoms persisted due to effusion loculation. A repeat chest CT showed reduced effusion size but continued loculation. Due to immunocompromise and malnutrition, he was not a candidate for thoracic duct ligation. Lytic therapy yielded over 1.1 L of chylous fluid. Lymphangiography attempts via bilateral inguinal lymph nodes failed as the contrast did not exit the pelvis, indicating diffuse lymphatic occlusion. A retrograde approach through the left brachial vein revealed thoracic duct occlusion
2-3 cm from its origin. MRI lymphangiogram confirmed a chronic occlusion. Successful
lymphangiography via the cisterna chyli (L1) showed a diminutive thoracic duct, and glue embolization was performed. Post-procedure, a chest CT showed a decreased right-sided effusion but an increased 32
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