Louisiana Research Day Program Book 2025

Case Studies: Section 2

Case Studies: Section 2

113 TAMOXIFEN- INDUCED LUPUS ERYTHEMATOSUS IN BREAST CANCER

114 MARANTIC ENDOCARDITIS: A RARE COMPLICATION OF ENDOMETRIAL ADENOCARCINOMA

Nisheem Pokharel, MD 1 ; Shekhar Gurung, MD 2 ; Rama Tamrakar, MD 3 ; Edward Cornell Pierce, MD 4 ; Navin Ramlal, MD 5 St. Francis Medical Center, Monroe, Louisiana

Nisheem Pokharel, MD 1 ; Deekshitha Manney, MD 1 ; Mary Youssief 2 ; Harikrishna Bandla, MD 1 1 St. Francis Medical Center, Monroe, LA; 2 VCOM-Louisiana

Introduction: Drug induced lupus erythematosus (DILE) is a rare autoimmune disorder resulting from a hypersensitivity reaction to certain medications, usually on chronic exposure and resolves when the offending drug is withdrawn. DILE is commonly associated with drugs such as procainamide and hydralazine, however association with selective estrogen receptor modulator such as tamoxifen use is extremely rare (<1%). Here, we report a case of tamoxifen-induced lupus in a patient on adjuvant therapy for breast cancer. Case Presentation: A 80 year-old female currently on tamoxifen for ER positive breast cancer status post left breast lumpectomy and radiation therapy, presented with malaise and persistent low grade fever. Physical examination was unremarkable. Laboratory workup showed mild anemia, mild thrombocytopenia, elevated ESR,ferritin and BUN and creatinine. CT chest was unremarkable and CT abdomen showed mesenteric panniculitis. There was no obvious source of infection, however, empiric antibiotics ceftriaxone and doxycycline were initiated for pyrexia and extensive infectious workup was done. Despite antibiotic therapy, over the

next few days, her condition worsened, with high grade fever, nausea and hypoxia with increasing oxygen demand. Her kidney function deteriorated, possibly from acute tubular necrosis due to medications. Negative infectious workup including blood and urine culture prompted autoimmune testing that revealed positive ANA, anti-chromatin antibody, elevated anti-dsDNA antibody (>300) , and anti-histone antibody leading to a diagnosis of drug-induced lupus. Also, finding of mesenteric panniculitis was explained with diagnosis of lupus, given its association. After reviewing her medication list, the only new medication that stood out was tamoxifen. Withholding the tamoxifen and starting treatment with intravenous steroids improved her symptoms following which she was discharged with rheumatology follow-up for lupus management. Discussion: Although systemic lupus erythematosus (SLE) and DILE share clinical features, DILE generally occurs in older patients and lacks significant organ involvement. Furthermore, anti-histone antibodies are more common in DILE, while malar rash and oral ulcers are not. Diagnosis depends on

association between drug exposure with symptom onset, and discontinuation of the drug along with corticosteroid use leading to improvement. Hereby, this case emphasizes the need to consider DILE as a possible complication of tamoxifen therapy.

Introduction: Marantic endocarditis, also known as non-bacterial thrombotic endocarditis (NBTE), is a rare with an incidence of 1.25% in patients with malignancy and only 0.25% in the general population. NBTE is often under diagnosed because it is not recognized until the time of autopsy in many cases. Here, we present a case of marantic endocarditis in a patient with endometrial adenocarcinoma. Case Description: A 75-year-old female presented with complaints of generalized weakness, shortness of breath, cough and weight loss of several months. Due to high suspicion for an underlying maligancy, CT imaging of her chest, abdomen and pelvis was obtained revealing bilateral pleural effusions, moderate ascites and extensive abdominal adenopathy. In addition to this, she also had a notable pelvic mass. She underwent biopsy of the mass, confirming high grade clear cell endometrial adenocarcinoma. Cytology from her thoracentesis and paracentesis also showed malignant cells indicative of metastatic spread. Patient’s hospital stay was complicated by short runs of non-sustained ventricular tachycardia necessitating a cardiac workup. A

transthoracic echocardiogram was obtained and revealed multiple mitral valve vegetations. Subsequent blood cultures all remained without any growth. Patient was started on apixaban for NBTE secondary to her malignancy and referred to hematology-oncology for further management. Discussion: Gynecologic tumors are less often implicated in development of NBTE and there are very few cases in current literature describing NBTE with endometrial adenocarcinoma. NBTE can occur as a complication of advanced malignancies but often goes unrecognized. Clinicians should maintain a high level of suspicion for malignancy and associated nonbacterial thrombotic endocarditis in patients with an otherwise unexplained hypercoagulable states to prevent associated morbidity and mortality.

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129 2025 Research Recognition Day