was considered in this patient for long-term nutrition. Elderly symptomatic patients may be denied surgical intervention of symptomatic diverticulum despite its effectiveness in symptom resolution and improved quality of life. Although surgery is
safe, management of symptomatic esophageal diverticulum in the elderly involves goals of care discussions and shared decision making to achieve improved quality of life in these patients.
MULTIPLE MYELOMA PRESENTING AS FLUID OVERLOAD Luke Yesbeck, Parker Yount, Kaleb Robin, Lauren deLeon, Mohammed Ziada; Department of Medicine, LSU Health Sciences Center, New Orleans, LA.
Introduction: Multiple Myeloma (MM) is a plasma cell malignancy affecting over 150,000 people each year with an increase in incidence since 1990. Uncommon presentations of MM cause delays in diagnosis. Congestive heart failure (CHF) due to cardiac amyloidosis can be seen in 15% of patients already carrying the diagnosis of MM, and macrocytosis can be present in 20-30% of patients with MM. Herein, we describe a rare initial presentation of MM in an otherwise healthy man requiring hospitalization due to CHF and macrocytic anemia without typical MM features. Case: A 73-year-old man with no chronic medical issues presented with progressively worsening dyspnea on exertion and fatigue without chest pain for one year and bilateral lower extremity and scrotal edema for two months. On admission, physical exam was significant for elevated jugular venous pressure, rales, and anasarca. Laboratory results revealed macrocytic anemia (Hgb 10.3 g/dl, MCV 105 fl) and proteinuria (300 mg/dl). EKG was significant for low voltage and left anterior fascicular block. Imaging demonstrated right-sided pleural effusion and Echocardiography showed abnormal heart strain
with bi-atrial dilation and normal left ventricular systolic function. He had an elevation in lambda light chains (1,171 mg/dL) with low kappa/lambda light chain ratio (0.01), and serum protein electrophoresis exhibited elevated beta 2 monoclonal protein and low gamma globulin levels. Diuretics successfully managed the patient’s symptoms prior to discharge. Outpatient workup revealed lytic calvarial lesions, deformity of thoracic vertebrae, and mottled marrow space in long bones. Biopsy revealed plasma cell neoplasm occupying 80% of cellular marrow spaces, mono-typical for lambda light chain on immunohistochemical staining, indicative of plasma cell myeloma. Cardiac magnetic resonance imaging results were representative of cardiac amyloidosis. Discussion: Immunoglobulin light chain amyloidosis associated with MM occurs when fragments of immunoglobulin light chains are deposited in tissues. Depending on the organ involved, patients may have heart failure, nephrotic syndrome, hepatic dysfunction and, peripheral/autonomic neuropathy. MM should be on the differential in patients with fluid overload when echocardiogram shows bi-atrial enlargement of the heart and abnormal strain.
APLASTIC ANEMIA WITHIN FEW MONTHS OF RECEIVING A SOLID ORGAN TRANSPLANT Navneet Kaur, David M. Hudson, Jr; Department of Medicine, Willis Knighton Health System, Shreveport, LA.
Introduction: Aplastic anemia is a rare but life- threatening blood disorder in which the bone marrow fails to produce enough blood cells. It requires prompt treatment, but the multitude of different etiologies that can cause pancytopenia in solid transplant patients makes it a diagnostic challenge.
month after transplant, he was found to have an elevated lipase, anemia and acute renal failure with life-threatening hyperkalemia. He was admitted for emergency hemodialysis and was worked up for possible transplant rejection. During his hospital stay, he received empiric treatment for rejection with methylprednisolone and increased dosages
Case: A 45-year-old man with type I diabetes who had received simultaneous pancreas-kidney (SPK) transplant had been stable on tacrolimus, mycophenolate mofetil and prednisone. He was also receiving valganciclovir for CMV prophylaxis. One
of tacrolimus and mycophenolate. His anemia was unresponsive to epoetin alfa however. On biopsy, he tested negative for rejection but had to be readmitted within a month for pancytopenia and COVID. He was unresponsive to granulocyte 39
Made with FlippingBook Digital Publishing Software