A0543 - An Atypical Source of Thrombocytopenia

Tyson Broadbent, MD¹, John S. Kelley, MD¹, Lancaster Weld, DO^2
1Baylor Scott and White, Temple, TX; ²Baylor Scott and White Healthcare, Temple, TX

Introduction: We report a 29-year-old pregnant female with a past medical history notable for poorly controlled ulcerative colitis, recurrent c.diff, recent stent placement for choledocholithiasis with retained stent who was found to have a rare neuroendocrine adenocarcinoma with enteroblastic morphology following extensive workup for thrombocytosis .

Case Description/Methods: Patient had cholecystectomy due to ruq pain six months prior to admission.ERCP was performed with findings indicating choledocholithiasis for which she underwent stent placement. Due to lapse in insurance stent removal was not performed. Patient began to experience increased abdominal pain and and ct revealed a new soft tissue density involving the porta hepatis and gastrohepatic regions concerning for soft tissue mass, at which time she additionally discovered she was pregnant. OSH elected to not remove stent or biopsy mass at time due to pregnancy. She continued to experience abdominal pain with new radiation to back. Patient was initially transferred for evaluation of thrombocytosis platelet count of 1.2 million with multiple potential etiologies. Patient’s ulcerative colitis was not treated so underwent flexible sigmoidoscopy which demonstrated friable tissue in active ulcerative colitis flare. Other etiologies that were evaluated included retained biliary stent, patient was also found to be C diff positive without toxin, additionally was found to be Campylobacter positive for which she underwent antibiotic treatment. Following initiation of ulcerative colitis therapy and exchange of biliary stent patient had some improvement in right upper quadrant pain but continued to have thrombocytosis. Patient underwent biopsy of abdominal lymphadenopathy which showed signs concerning for hepatocellular carcinoma. Due to concerns probability of hepatocellular carcinoma patient underwent repeat biopsy which demonstrated findings concerning for neuroendocrine tumor with yolk sac features.

Discussion: Patient was followed by multiple services including heme Onc, Gastroenterology, Maternal-Fetal Medicine who initiated treatment with chemotherapy while the patient was still pregnant, and ultimatelyly she had successful delivery of child. patient ultimately ending up passing away following progression of disease. This case helps to demonstrate the need for broad differential and the ability to reexamine assumed diagnosis in addition to constraints associated with socioeconomic factors impacting care.


Disclosures:


Tyson Broadbent, MD¹, John S. Kelley, MD¹, Lancaster Weld, DO². A0543 - An Atypical Source of Thrombocytopenia, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.