Discussion: This case depicts an uncommon manifestation and feature of SLE. DAH has been reported to complicate 2-5% of all cases of SLE. Our patient was not previously diagnosed with SLE; her first manifestation was DAH. In one case study from Europe, DAH was the initial manifestation in 3 out of 15 patients secondary to SLE (20%) as compared to 11% in literature series. This study also reported lupus nephritis frequently (14 out of 15 cases) with DAH. Overall mortality rate was 53% in that series and 50% in the literature series. Factors associated with increased mortality were mechanical ventilation, infection and cyclophosphamide therapy for the acute DAH episode. Our patient had all of these factors coupled with DAH, and yet improved to be discharged and seen as an outpatient.
PSEUDOPROGESSION OF BREAST CANCER WITH OLAPARIB
WHAT LIES BENEATH: A CASE OF DIFFUSE ALVEOLAR HEMORRHAGE SECONDARY TO SYSTEMIC LUPUS ERYTHEMATOSUS D. Davda; T. Kalaria; A. Pujari; R. Arora; S. Kulkarni Department of Internal Medicine, LSU Health Sciences Center - Shreveport Introduction: alveolar hemorrhage (DAH) is a rare and serious complication of systemic lupus erythematosus (SLE). This case describes a female who had DAH and nephritis secondary to newly diagnosed lupus, and her successful response to therapy. While most DAH cases in SLE present around ages 20-40, she presented in her 60s with a significant mortality risk. Diffuse Case: This patient was admitted for progressive shortness of breath, productive cough, and hemoptysis for 2 days. Past medical history was noted for breast cancer, liver cirrhosis secondary to presumednon-alcoholic fatty liver disease complicated with portal hypertension, asthma, obstructive sleep apnea, and hypertension. Physical examination was remarkable for rales in the right lower lung base that progressed to the left side. Significant labs included a hemoglobin of 6 g/dl from a baseline of 9 g/dl, platelet creatinine 3.3 mg/dl from a baseline of ~15 mg/dl and 1.3 mg/dl respectively. Urinalysis showed large blood and proteinuria. CT chest showed bilateral airspace consolidations and ground glass opacities suggestive of diffuse alveolar hemorrhage. Workup was positive for multiple autoimmune markers; leading differential at onset wasmixed connective tissue disease vs granulomatosis with polyangiitis. She initially required intubation with mechanical ventilation and produced bloody secretions from endotracheal tube, confirming suspicion for DAH. Kidney biopsy was consistent with stage 3 and 4 lupus nephritis. Her final diagnoses were lupus nephritis and diffuse alveolar hemorrhage secondary to SLE. She received glucocorticoids and plasmapheresis for 5 sessions and started cyclophosphamide. Respiratory status and kidney function gradually improved. Eventually she was discharged with improved imaging and kidney function on 3 month follow up.
O. Symczyk¹; G. O’Bryan¹; R. Vargas² ¹Department of Internal Medicine and ²Department of Hematology and Oncology, Leonard J. Chabert Medical Center, Houma Introduction: Second to skin cancer, regardless of race and ethnicity, breast cancer is among the leading cancers diagnosed in women in the United States, with triple negative breast cancer (TNBC) representing approximately 15- 20% of all breast cancer cases. TNBC is also known to have a high recurrence rate, with approximately 30% of women experiencing a recurrence within 2.6 years of initial diagnosis. Due to a lack of estrogen, progesterone or HER- 2 receptors, TNBC has typically been treated with a combination of surgery, chemotherapy and radiation therapy. This past year, olaparib, a poly (ADP-ribose) polymerase inhibitorwas approved for the germline BRAC mutation HER2-negative metastatic breast cancer in patients previously treated with chemotherapy in a neoadjuvant, adjuvant or metastatic setting. As with the initiation of any therapy, risks versus benefits must be outweighed. Case: A 39 year old Hispanic woman with a history of Invasive Ductal Carcinoma of the left breast clinically Staged as IIA triple negative grade 3 breast cancer where therapy with olaparib was almost discontinued due to pseudoprogression of metastatic disease after the initiation of therapy. The patient previously underwent left modified radical mastectomy, was treated with 4 cycles of doxorubicin/cyclophosphamide followed by four cycles of paclitaxel/carboplatin which were discontinued secondary to severeadverse reaction. She subsequently completed 4 months of treatment with capecitabine. Sheunderwentprophylactic right mastectomy a year later, reported negative for malignancy. Recurrence of breast cancer was diagnosed following symptomatic right shoulder pain with CT chest demonstrating a mass 6.5 x 4 cm in the right paracervical area which was biopsy confirmed. She was started on olaparib 300 mg twice daily. Repeat CT chest due to progressively worsening shortness of breath and fevers
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