understood and very few studies have reported an association between RTA and rheumatoid arthritis.
gap metabolic acidosis with pH 7.20, PaO2 120, and PaCO2 25 on room air. She was transferred to the ICU for closer monitoring with concern for possible RTA. Her previous sedimentation rate had never been elevated above 28 so there was some concern for a rheumatoid flare. Nephrology was consulted and further labs were performed showing hypokalemia with an elevated urine pH and an elevated urine anion gap consistent with distal RTA. She was placed on a bicarbonate drip and her potassium was repleted appropriately. Her respiratory status improved significantly, and she was transferred out of the ICU. Discussion: This case further illustrates the association between RTA and autoimmune disorders. It also demonstrates the importance of monitoring inflammatory markers in patients with rheumatoid arthritis ensuring prompt diagnosis and early treatment of complications to avoid further comorbidities.
Case: A 75-year-old women with rheumatoid arthritis who presented with complaints of new- onset dyspnea on exertion. The patient had recently been discharged from the hospital 1 month prior after receiving a left total knee arthroplasty. She was found to have an elevated D-dimer of 1.2 and an acute kidney injury with a BUN/creatinine level of 29/1.58. Her other inflammatory markers were also found to be elevated with a sedimentation rate of 116 and a CRP of 63.01. She was admitted to the hospital for fluid resuscitation and to rule-out a pulmonary embolism. She received a V/Q scan which was negative for PE. She was placed on 5L nasal canula and continued to have increased oxygen requirements throughout her stay with continued complaints of shortness of breath. Pulmonology was consulted for further workup and an arterial blood gas was obtained which showed a non-anion
A RARE CASE OF HYPERPARATHYROIDISM SECONDARY TO MEDIASTINAL PARATHYROID CARCINOMA Chukwunoso Ezeani, Gift Echefu, Ifeoluwa Stowe, Shatha Murad; Department of Medicine, Baton Rouge General Medical Center, Baton Rouge, LA.
Introduction: Parathyroid carcinoma (PC) is rare with a reported prevalence of 0.005% of all tumors. Ectopic parathyroid glands localized to the mediastinum are even rarer and have similar pathophysiologic presentation as parathyroid adenomas (PA) making diagnosis arduous. We present a patient with recurrent hyperparathyroidism initially from PA but then had recurrence of his symptoms with a diagnosis of mediastinal parathyroid carcinoma. Case: A 73-year-old male presented with nervousness and generalized weakness of 2 weeks duration. He also had polyuria, polydipsia and bone pain. Medical history includes stage IV CKD and primary hyperparathyroidism with cervical parathyroid adenoma diagnosed a year prior for which he had subtotal parathyroidectomy, with benign histology. At presentation, his vital signs were stable. Strength was 3/5 in all extremities while other systemic examination was unremarkable. Labs revealed hypercalcemia (14.8mg/dL), elevated parathyroid hormone (1173pg/mL), normal phosphorus and Vitamin D. A diagnosis of primary hyperparathyroidism was made. The source was
initially thought to be the implanted gland in his arm, but ultrasound of the implantation site showed normal subcutaneous tissue. Nuclear medicine/ Sesatimibi parathyroid scan revealed persistent oblong uptake in the mediastinum suspicious for parathyroid adenoma. Chest CT showed 4.1 x 1.9cm soft tissue density in the anterior aspect of the superior mediastinum. He was managed with aggressive IV hydration with isotonic fluid, calcitonin x48 hours, Cinacalcet and one-time pamidronate. He underwent robotic mediastinal tumor resection with redo neck exploration, total parathyroidectomy and thymectomy. Histopathology revealed parathyroid carcinoma positive for chromogranin, GATA3 and PTH. Postoperatively, he was managed with calcium carbonate, Vit-D and calcitriol with improvement in his symptoms and biochemical parameters. Discussion: The extreme rarity of this condition poses diagnostic and therapeutic challenges for clinicians. Clinical and biochemical parameters may help in the differential diagnosis. The average diameter, weight, serum calcium (>14.2 mg/dl), parathyroid hormone (>1,000 pg/ml), and rates of 10
Made with FlippingBook Digital Publishing Software