organ failure. Weil’s Disease, a severe manifestation, involves widespread hemorrhage accompanied by acute liver and kidney failure. Diagnosis can be delayed due to low clinical suspicion in non-endemic regions and the non-specific nature of symptoms at
onset, which can be confused for other diseases. Early recognition and high clinical suspicion is necessary to establish the diagnosis and initiate treatment to prevent serious sequelae, morbidity, and mortality.
MARANTIC ENDOCARDITIS: A RARE COMPLICATION OF ENDOMETRIAL ADENOCARCINOMA Nisheem Pokharel, Mary Youssief, Deekshitha Manney, Harikrishna Bandla; St. Francis Medical Center, Monroe, LA.
Introduction: Marantic endocarditis, also known as non-bacterial thrombotic endocarditis (NBTE), is rare with an incidence of 1.25% in patients with malignancy and only 0.25% in the general population. NBTE is often under-diagnosed because it is not recognized until the time of autopsy in many cases. Case: A 75-year-old female presented with complaints of generalized weakness, shortness of breath, cough and weight loss of several months. Due to high suspicion for an underlying maligancy, CT imaging of her chest, abdomen and pelvis revealed bilateral pleural effusions, moderate ascites and extensive abdominal adenopathy. In addition to this, she also had a notable pelvic mass. She underwent biopsy of the mass, confirming high grade clear cell endometrial adenocarcinoma. Cytology from her thoracentesis and paracentesis also showed malignant cells indicative of metastatic spread. The patient’s hospital stay was complicated by
short runs of nonsustained ventricular tachycardia necessitating a cardiac workup. A transthoracic echocardiogram was obtained and revealed multiple mitral valve vegetations. Subsequent blood cultures all remained without any growth. The patient was started on apixaban for NBTE secondary to her malignancy and referred to hematology-oncology for further management. Discussion: Gynecologic tumors are less often implicated in development of NBTE and there are very few cases in current literature describing NBTE with endometrial adenocarcinoma. NBTE can occur as a complication of advanced malignancies but often goes unrecognized. Clinicians should maintain a high level of suspicion for malignancy and associated nonbacterial thrombotic endocarditis in patients with an otherwise unexplained hypercoagulable states to prevent associated morbidity and mortality.
TAMOXIFEN -INDUCED LUPUS ERYTHEMATOSUS IN BREAST CANCER. Nisheem Pokharel, Shekhar Gurung, Rama Tamrakar, Edward Cornell Pierce, Navin Ramlal; St. Francis Medical Center, Monroe, LA.
Introduction: Drug induced lupus erythematosus (DILE) is a rare autoimmune disorder resulting from a hypersensitivity reaction to certain medications, usually on chronic exposure and resolves when the offending drug is withdrawn. DILE is commonly associated with drugs such as procainamide and hydralazine, however association with selective estrogen receptor modulator such as tamoxifen use is extremely rare (<1%).
lumpectomy and radiation therapy, presented with malaise and persistent low grade fever. The physical examination was unremarkable. Laboratory workup showed a mild anemia, mild thrombocytopenia, elevated ESR, ferritin, BUN and creatinine. A CT of the chest was unremarkable but a CT of the abdomen showed mesenteric panniculitis. There was no obvious source of infection, however, empiric antibiotics (ceftriaxone and doxycycline) were initiated for pyrexia and an extensive infectious workup was done. Despite antibiotic therapy, over the next few days, her condition worsened, with 40
Case: A 80 year-old female currently on tamoxifen for ER positive breast cancer status post left breast
Made with FlippingBook Digital Publishing Software