an ejection fraction of 55% with grade II diastolic dysfunction. A transesophageal echocardiogram was done showing severely thickened mitral valve leaflets and severe mitral regurgitation with a posteriorly directed flow. Throughout her stay, she was effectively diuresed with improvements in clinical symptoms increasing the likelihood that the etiology of her effusion was secondary to acute on chronic systolic heart failure exacerbation secondary to severe mitral regurgitation. Cardiothoracic
surgery was consulted recommending outpatient follow-up for potential mitral valve replacement and she was discharged in stable condition. Discussion: We present an uncommon case of a unilateral pleural effusion in the setting of severe mitral regurgitation. Due to the posterior flow of the mitral regurgitation, it was likely that the posteriorly directed jet was directly responsible for creating a unilateral pleural effusion.
CROHN’S DISEASE IN A PATIENT WITH A HISTORY OF HEMOLYTIC UREMIC SYNDROME. Brendan Tate 1 , Brandon Dang 1 , Alexandra Anderson MD 2 , Sepehr Sadeghi MD 2 , School of Medicine 1 , Department of Medicine 2 , LSU Health New Orleans, New Orleans, LA.
Introduction: Chronic intermittent diarrhea is a common manifestation of Crohn’s disease. In patients with chronic diarrhea, it is important to establish a differential diagnosis that encompasses a wide variety of etiologies. Several cases of HUS in patients with a previous diagnosis of IBD have been reported, but there is limited evidence to suggest that HUS can provoke the development of Crohn’s disease. Case: A 35-year-old male with hemolytic uremic syndrome/MAHA, post-infectious glomerulonephritis, nephrotic syndrome, and hypertension presented with abdominal pain and profuse diarrhea of 3 weeks duration. He experienced at least 10 episodes of daily diarrhea with several nighttime awakenings. He initially developed these symptoms after consuming a plate of leftover “red beans” that had not been refrigerated. He reports experiencing profuse diarrhea for several months with spontaneous remission around 8 months ago. He had been hospitalized 3 months prior for anemia and lower extremity edema with nephrotic range proteinuria. He was subsequently diagnosed with post-infectious glomerulonephritis via renal biopsy. His peripheral blood smear at the time was
suggestive of microangiopathic hemolytic anemia with concern for Hemolytic uremic syndrome vs thrombotic thrombocytopenic purpura. His labs during his current admission were notable for lymphocytosis with eosinophilia and thrombocytosis. Broad infectious workup including Strongyloides antibody, stool ova/parasite, giardia/cryptosporidium antigen, and gastrointestinal PCR panel were all negative. CT of the abdomen/pelvis revealed diffuse abnormal enhancement of the colon suggestive of colitis. Gastroenterology consultation recommended further evaluation with colonoscopy, which revealed severe colonic Crohn’s disease. The patient was discharged 6 days later on methotrexate and infliximab therapy. His symptoms were greatly improved on outpatient follow-up 1 month later. Discussion: We present a case of severe Crohn’s disease diagnosed in a patient with a history of hemolytic uremic syndrome. While it is unclear if this patient had undiagnosed Crohn’s disease when he developed HUS, further studies are needed to investigate the relationship between these conditions.
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