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P-263: Cryptogenic organizing pneumonia: a rare syndrome even in the elderly. Case report
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Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
P-263 Cryptogenic organizing pneumonia: a rare syndrome even in the elderly. Case report S. Zannoni1 , C. Lorenzi2 , M. Paoli2 , F. Orso3 , M. Torrini4 , M. Rafanelli5 , G. Toffanello5 , A. Giordano6 , F.C. Gori Sacco4 , N. Marchionni3 , A. Ungar7 1 AOU Careggi Universit` a degli studi Firenze, Firenze, Italy; 2 AOU Careggi Universit` a degli studi Firenze, Florence, Italy; 3 Geriatric Cardiology and Medicine, Careggi Univesrity Hospital, Florence, Florence, Italy; 4 Geriatric Cardiology and Medicine, Careggi Univesrity Hospital, Florence, Italy; 5 Geriatric Cardiology and Medicine, University of Florence and AOU Careggi, Florence, Italy; 6 Italy; 7 Azienda Ospedaliero Universitaria Careggi, Florence, Italy Patient: Woman 88 years. Hospitalizazion for persistent low-grade fever and dyspnea with worsening of respiratory exchanges. Chest CT with contrast showed the involvement of the upper and lower interstitial lung lobes with bilateral pleural effusions. Empirical antibiotic therapy for nosocomial pneumonia was started. For the persistence of symptoms was placed on suspicion of cryptogenic Organizing Pneumonia (COP). It was undertaken therapy with high dose of corticosteroids with rapid clinical and radiological improvement. A chest CT pre-discharge featured complete resolution of pulmonary consolidations. The patient is currently in good condition and assumes prednisone 12.5 mg / day. Results: COP appears most frequently in the fifth-sixth decade of life and affects men and women equally. It begins with cough, dyspnea, fever, malaise and weight loss. Breathing pattern directs toward the diagnosis of pneumonia, confirmed by radiological evidence: typical is the presence of opacity, circumscribed or diffuse, or consolidations with ground-glass appearance, often migrants, with bilateral and peripheral distribution. The most effective therapy is long-term administration of corticosteroids at high doses that are gradually climbing in 6–12 months. The complete resolution of the clinical picture and the normalization of the radiological image usually occurs in 2/3 of patients. In patients who don’t respond to steroid therapy is necessary to reconsider the initial diagnosis of COP. Conclusion: This case report may be useful for Geriatricians, since our patient developed the disease beyond 80 years. The clinical course may be similar to more frequent polymyalgia rheumatic in the elderly, but these are just hypotheses. P-264 Autoimmune hemolytic anemia in the elderly over 75 years: report of a rare retrospective study A.-A. Zulfiqar1 , R. Mahdi1 , J.-L. Pennaforte1 , J.-L. Novella2 , E. Andres3 1 CHU Reims, Reims, France; 2 France; 3 CHRU Strasbourg, Strasbourg, France Objectives: Autoimmune hemolytic anemia is a rare disease in the elderly. Methods: Retrospective study over a period of 5 years, focused on two Internal Medicine Service (Reims and Strasbourg). Results: 7 patients were enrolled, including two men. The average age was 85.4 years. All had clinical signs of anemia (dyspnea, mucocutaneous pallor, . . . ), while clinical signs of hemolysis were very inconsistent. The mean hemoglobin level was 7.6 g / dl. No thrombocytopenia was associated; two hyperlymphocytosis were found. Haptoglobin was reduced for 5 patients, normal in the other two patients. Other biological hemolysis parameters were inconsistent. The blood smear found for all patients anisocytosis; no schistocyte is found (missing: 3). The Coombs test was positive for all patients: 4 patients had a mixed profile (IgG + C3d); 2 had a positive Coombs test type IgG alone, and only one patient had a
positive Coombs test type C3d alone. 3 patients had cold agglutinins (cold hemagglutinin disease). The etiological assessment found 4 cases of lymphoma, one case of chronic lymphocytic leukemia, one case of unclassified dysimmunity and idiopathic case. 4 patients received corticosteroid therapy (one patient was complicating with lumbar shingles and diabetes imbalance). Cold-protection measures have been advocated for 3 patients; immunosuppressive treatment for a single patient. One patient had, during its evolution, an association with idiopathic thrombocytopenic purpura; another patient died. Conclusions: This disease is difficult to diagnose in the elderly, because of its rarity; lymphoma and chronic lymphocytic leukemia being the main causes to look in the elderly. P-265 MGUS and dystrophy myeloma: blurred border P. Panek1 , A. Martin-Kleisch1 , L. Babe1 , J.-L. Novella2 , A.-A. Zulfiqar1 CHU Reims, Reims, France; 2 France
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Objectives: Monoclonal gammopathy of undetermined significance is a benign entity but very little diagnosed in the elderly; atypical cases are difficult to identify in the elderly. Methods: We illustrate this data by a clinical case. Results: A 89-year-old woman was hospitalized for fall without loss of consciousness. Normochromic normocytic aplastic anemia was detected. A serum protein electrophoresis showed an IgG monoclonal band kappa to 13.2 g/L, associated with proteinuria estimated at 266 mg/24h. Urine immunofixation also found IgG ú and l. The assessment was completed by a myelogram showing a plasma cell dystrophic inclusion estimated at 3%. A moderate chronic renal failure of unknown etiology has been present for one year. No hypercalcemia was found. Presence of two gaps X-rays of the skull were detected. LDH increased at 512 IU/L and high b2 microglobulin to 4.65 mg/L. Oncogeriatric assessment found risk of malnutrition, mixed dementia pathology moderate stage, a high risk of falls, a Cornell index 7/38 not in favor of a depression. Haematological advice was requested, concluding to a MGUS because only 3% of dystrophic plasma cells, but a dystrophy myeloma was not excluded. No therapeutic was expected because of her general condition and its comorbidities (colon cancer with discharge stoma, in remission since 2001, and discovery of a bilateral pulmonary embolism during her hospitalization). Biological monitoring was recommended. Conclusions: Atypical aspects in the elderly raise the problem of medical care, conditioned by an accurate evaluation oncogeriatric.
Geriatric rehabilitation P-266 Three different outcomes in older patients receiving intermediate care in nursing home after acute hospitalization J.F. Abrahamsen Storetveit Nursing homeMunicipality of Bergen and Kavli forskningssenter for Geriatri og Demens, HDS, Bergen, Norway Objectives: To evaluate the recovery and outcome of older community-dwelling patients admitted to intermediate care (IC) in nursing home after acute hospitalization, and to compare patients who were able and unable to return directly to their own homes. Patients and Methods: A prospective, observational, cohort study conducted between June 2011 and 2014 in a 19-bed IC nursing home ward with increased multidisciplinary staffing. A total of 961 community-dwelling patients, ≥70 years of age, considered to have a rehabilitation potential and no major cognitive impairment or delirium, transferred from internal medicine, cardiac, pulmonary and orthopaedic hospital departments were included.
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
P-263 Cryptogenic organizing pneumonia: a rare syndrome even in the elderly. Case report S. Zannoni1 , C. Lorenzi2 , M. Paoli2 , F. Orso3 , M. Torrini4 , M. Rafanelli5 , G. Toffanello5 , A. Giordano6 , F.C. Gori Sacco4 , N. Marchionni3 , A. Ungar7 1 AOU Careggi Universit` a degli studi Firenze, Firenze, Italy; 2 AOU Careggi Universit` a degli studi Firenze, Florence, Italy; 3 Geriatric Cardiology and Medicine, Careggi Univesrity Hospital, Florence, Florence, Italy; 4 Geriatric Cardiology and Medicine, Careggi Univesrity Hospital, Florence, Italy; 5 Geriatric Cardiology and Medicine, University of Florence and AOU Careggi, Florence, Italy; 6 Italy; 7 Azienda Ospedaliero Universitaria Careggi, Florence, Italy Patient: Woman 88 years. Hospitalizazion for persistent low-grade fever and dyspnea with worsening of respiratory exchanges. Chest CT with contrast showed the involvement of the upper and lower interstitial lung lobes with bilateral pleural effusions. Empirical antibiotic therapy for nosocomial pneumonia was started. For the persistence of symptoms was placed on suspicion of cryptogenic Organizing Pneumonia (COP). It was undertaken therapy with high dose of corticosteroids with rapid clinical and radiological improvement. A chest CT pre-discharge featured complete resolution of pulmonary consolidations. The patient is currently in good condition and assumes prednisone 12.5 mg / day. Results: COP appears most frequently in the fifth-sixth decade of life and affects men and women equally. It begins with cough, dyspnea, fever, malaise and weight loss. Breathing pattern directs toward the diagnosis of pneumonia, confirmed by radiological evidence: typical is the presence of opacity, circumscribed or diffuse, or consolidations with ground-glass appearance, often migrants, with bilateral and peripheral distribution. The most effective therapy is long-term administration of corticosteroids at high doses that are gradually climbing in 6–12 months. The complete resolution of the clinical picture and the normalization of the radiological image usually occurs in 2/3 of patients. In patients who don’t respond to steroid therapy is necessary to reconsider the initial diagnosis of COP. Conclusion: This case report may be useful for Geriatricians, since our patient developed the disease beyond 80 years. The clinical course may be similar to more frequent polymyalgia rheumatic in the elderly, but these are just hypotheses. P-264 Autoimmune hemolytic anemia in the elderly over 75 years: report of a rare retrospective study A.-A. Zulfiqar1 , R. Mahdi1 , J.-L. Pennaforte1 , J.-L. Novella2 , E. Andres3 1 CHU Reims, Reims, France; 2 France; 3 CHRU Strasbourg, Strasbourg, France Objectives: Autoimmune hemolytic anemia is a rare disease in the elderly. Methods: Retrospective study over a period of 5 years, focused on two Internal Medicine Service (Reims and Strasbourg). Results: 7 patients were enrolled, including two men. The average age was 85.4 years. All had clinical signs of anemia (dyspnea, mucocutaneous pallor, . . . ), while clinical signs of hemolysis were very inconsistent. The mean hemoglobin level was 7.6 g / dl. No thrombocytopenia was associated; two hyperlymphocytosis were found. Haptoglobin was reduced for 5 patients, normal in the other two patients. Other biological hemolysis parameters were inconsistent. The blood smear found for all patients anisocytosis; no schistocyte is found (missing: 3). The Coombs test was positive for all patients: 4 patients had a mixed profile (IgG + C3d); 2 had a positive Coombs test type IgG alone, and only one patient had a
positive Coombs test type C3d alone. 3 patients had cold agglutinins (cold hemagglutinin disease). The etiological assessment found 4 cases of lymphoma, one case of chronic lymphocytic leukemia, one case of unclassified dysimmunity and idiopathic case. 4 patients received corticosteroid therapy (one patient was complicating with lumbar shingles and diabetes imbalance). Cold-protection measures have been advocated for 3 patients; immunosuppressive treatment for a single patient. One patient had, during its evolution, an association with idiopathic thrombocytopenic purpura; another patient died. Conclusions: This disease is difficult to diagnose in the elderly, because of its rarity; lymphoma and chronic lymphocytic leukemia being the main causes to look in the elderly. P-265 MGUS and dystrophy myeloma: blurred border P. Panek1 , A. Martin-Kleisch1 , L. Babe1 , J.-L. Novella2 , A.-A. Zulfiqar1 CHU Reims, Reims, France; 2 France
1
Objectives: Monoclonal gammopathy of undetermined significance is a benign entity but very little diagnosed in the elderly; atypical cases are difficult to identify in the elderly. Methods: We illustrate this data by a clinical case. Results: A 89-year-old woman was hospitalized for fall without loss of consciousness. Normochromic normocytic aplastic anemia was detected. A serum protein electrophoresis showed an IgG monoclonal band kappa to 13.2 g/L, associated with proteinuria estimated at 266 mg/24h. Urine immunofixation also found IgG ú and l. The assessment was completed by a myelogram showing a plasma cell dystrophic inclusion estimated at 3%. A moderate chronic renal failure of unknown etiology has been present for one year. No hypercalcemia was found. Presence of two gaps X-rays of the skull were detected. LDH increased at 512 IU/L and high b2 microglobulin to 4.65 mg/L. Oncogeriatric assessment found risk of malnutrition, mixed dementia pathology moderate stage, a high risk of falls, a Cornell index 7/38 not in favor of a depression. Haematological advice was requested, concluding to a MGUS because only 3% of dystrophic plasma cells, but a dystrophy myeloma was not excluded. No therapeutic was expected because of her general condition and its comorbidities (colon cancer with discharge stoma, in remission since 2001, and discovery of a bilateral pulmonary embolism during her hospitalization). Biological monitoring was recommended. Conclusions: Atypical aspects in the elderly raise the problem of medical care, conditioned by an accurate evaluation oncogeriatric.
Geriatric rehabilitation P-266 Three different outcomes in older patients receiving intermediate care in nursing home after acute hospitalization J.F. Abrahamsen Storetveit Nursing homeMunicipality of Bergen and Kavli forskningssenter for Geriatri og Demens, HDS, Bergen, Norway Objectives: To evaluate the recovery and outcome of older community-dwelling patients admitted to intermediate care (IC) in nursing home after acute hospitalization, and to compare patients who were able and unable to return directly to their own homes. Patients and Methods: A prospective, observational, cohort study conducted between June 2011 and 2014 in a 19-bed IC nursing home ward with increased multidisciplinary staffing. A total of 961 community-dwelling patients, ≥70 years of age, considered to have a rehabilitation potential and no major cognitive impairment or delirium, transferred from internal medicine, cardiac, pulmonary and orthopaedic hospital departments were included.