be obtained before any action could be taken. A biopsy of the cervical lymphadenopathy showed carcinosarcoma proven by immunohistochemical staining performed by Pathology. Given the diagnosis of this highly malignant cancer and the patient’s extensive comorbidities, no intervention was undertaken. The patient’s family
made the decision to palliatively extubate.
Discussion: This case demonstrates the importance of prompt and early diagnosis of uterine cancer and the potential for rapid metastasis and severe outcomes.
SEVERE STATIN INDUCED RHABDOMYOLYSIS: DOES THE DOSE MAKE THE POISON? Ifeoluwa Stowe, Gift Echefu, Rameela Mahat, Vasudev Tati; Department of Medicine, Baton Rouge General Medical Center, Baton Rouge, LA.
Introduction: Statins are among the breakthroughs of modern medicine. A growing proportion of patients are becoming eligible for statin use due to evidence of its reduction of cardiovascular risks. Rhabdomyolysis is a rare but potentially severe adverse effect of statins often reported in a dose-dependent pattern. It has mostly been documented to occur within at least a month of initiation. We describe a middle-aged male who developed severe rhabdomyolysis within 12 hours of initiation of low-dose rosuvastatin. Case: A 53-year-old male presented with generalized weakness and myalgias of 3 days duration. His symptoms progressed to multiple episodes of vomiting and diarrhea, fever, poor appetite, abdominal pain and oliguria. 12 hours prior to symptoms, he had taken the first dose of rosuvastatin 5mg. He had no other change in his usual routine including; medication changes, trauma, excessive physical exertion. He was a non-smoker but drank about 4-6 cans of 8 oz beer daily which was unchanged and did not use recreational drugs. On exam, he had stable vital signs, on room air, except for elevated blood pressure of 164/108mmHg. The remaining physical
examination was normal. Laboratory results revealed leukocytosis; elevated creatine kinase [>200,000] and creatinine; transaminitis and hypocalcemia. Urinalysis revealed protein 4+, blood 3+ with no RBCs visualized on microscopy. A diagnosis of severe rhabdomyolysis complicated by stage III acute kidney injury was made. Additional studies to exclude other causes of rhabdomyolysis were negative including screening for drugs of abuse. He was initiated on aggressive IV hydration without improvement in renal function and subsequently needed hemodialysis [HD]. Evaluation for genetic susceptibility based on statin transporter gene SLC 01 B1 *5 allele was negative. He was HD-dependent for one month with eventual recovery of renal function. At 3 months outpatient visit, serum creatinine had returned to baseline and he remained off HD. Discussion: Though statin-related rhabdomyolysis (SRR) is reported in dose and time-dependent patterns, this case illustrates the potential for a severe presentation to occur with low-dose rosuvastatin within a short period of initiation. Of all culprit genomic alleles, SLCO1B1 has the most association with SRR but is neither sensitive nor specific.
PARCHED FOR PULMONARY EMBOLISM: RARE CASE OF MALIGNANCY ASSOCIATED CENTRAL DIABETES INSIPIDUS WITH CONCURRENT VENOUS THROMBOSIS. Aleeza Qamar, Nicole Wiley, McKailey Salard, Shahzeem Bhayani; Department of Medicine, Louisiana State University, Shreveport, LA.
Introduction: Unexplained venous thrombosis (VTE) poses a clinical challenge in the acute setting. We report a rare case of a pulmonary embolism and incidental central diabetes insipidus (CDI) which was later found to have gastric adenocarcinoma.
history was admitted to ICU for a submassive pulmonary embolism, managed with therapeutic low-molecular-weight heparin, and eventually transferred to the floor. She was transitioned to apixaban, but continued to have hypernatremia, with polyuria. Urine studies show low urine osmolarity with high serum osmolarity without hyperglycemia 23
Case: A 67-year-old female with no past medical
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