excessive glucocorticoid production and pyrexia may result in tumor cell death. The clinical course of STLS is often subacute and the electrolyte derangements build up at a much slower rate compared to TLS but with more fatal outcomes. Extramedullary hematopoiesis (EMH) in myelofibrosis has been hypothesized to be caused by stem cell reactivation,
although pericardial involvement remains a rare phenomenon. STLS and EMH have been reported to be a complication of disease progression or leukemic transformation. Due to its inadvertent nature, patients with STLS lack the advantage of pretreatment and is usually associated with a high mortality, hence it must be identified early.
POLYCYTHEMIA VERA PRESENTING AS ATYPICAL COVID 19 INFECTION RELATED THROMBOSIS Andikan Udoh, Gift Echefu, Ifeoluwa Stowe, Vatsavai Raju, Lauren Juneja; Department of Medicine, Baton Rouge General Medical Center, Baton Rouge, LA.
Introduction: Severe Corona virus 2019 (COVID-19) disease manifests mainly as acute respiratory syndrome, however, extra-pulmonary complications including vascular thrombosis may occur. Splanchnic venous thrombosis is an uncommon form of venous thromboembolism that may be the initial presentation of myeloproliferative disorders. Case: 46-year-old female presented with shortness of breath, epigastric abdominal pain with nausea and vomiting of 5 days duration. She had a positive covid test on day 2 and was at home under quarantine, undergoing supportive management. However, her abdominal pain became intractable prompting her visit to the hospital. At presentation, her vital signs were stable. Physical exam revealed moderate epigastric tenderness without peritoneal signs, otherwise normal. Labs showed a hemoglobin of 17 g/dL that decreased to 13 g/dL on day 2 following aggressive fluid resuscitation. She also had leukocytosis and mild lactic acidosis. Other labs were normal. Abdominal CT scan and ultrasound revealed splenomegaly with portal and splenic vein thrombosis. Enoxaparin was initiated and changed to apixaban at discharge. Outpatient evaluation by hematologist including review of old records
showed erythrocytosis prompting JAK2 testing that was positive. Over the following months, patient required hospitalizations for hyperviscosity syndrome and management with plasmapheresis. She was maintained on cytoreductive therapy and will be undergoing an allogenic bone marrow transplant. Discussion: PCV is inherently a hypercoagulable condition resulting from blood hyperviscosity with 2-4-fold increased risk of vascular thromboembolism. Similarly, COVID 19 disease promotes a hypercoagulable milieu multiplying thrombotic risks in patients with PCV. PCV is uncommon in young people but may manifest earlier in the presence of inciting conditions such as in this patient. Therefore, young patients presenting with atypical COVID 19 thrombosis should undergo further work up for other hypercoagulable disorders. Once splanchnic vein thrombosis is diagnosed, urgent anticoagulation is advocated to prevent the risk of further complications such as intestinal or splenic infarctions. Due to disturbances in the clotting pathways, these individuals are also at significant bleeding risk, a crucial factor to consider before initiating antithrombotic therapy.
A RARE CASE OF EXTRAPULMONARY SMALL CELL CARCINOMA PRESENTING AS ABDOMINAL PAIN Katelyn Forest, Andikan Udoh, Michael Barker; Department of Medicine, Baton Rouge General Medical Center, Baton Rouge, LA.
Introduction: Gastric small cell carcinoma is an exceedingly rare form of extrapulmonary small cell carcinoma (EPSCC). It has an aggressive clinical course with a poor prognosis. It usually involves distant metastases at the time of diagnosis and requires early initiation of therapy.
presented with intermittent epigastric abdominal pain and bloating for the past two years, which was unrelieved with pantoprazole. He denied any bloody stools, black tarry stools, change in bowel habits, dysphagia, nausea, or vomiting. Physical exam revealed mild epigastric tenderness. Laboratory workup was unremarkable. Patient then underwent EGD, which revealed an ulcerating, 19
Case: A 63-year-old male with hypertension
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