Case
SLE and Carcinoid Tumours.

Age: 27
Sex: Female
Race: arab

History
History of present illness:
known case of SLE controlled on steroids but presented with ecchymosis & severe resistant thrombocytopenia to all measures (pulse steroids, Ig ,etc) so bone marrow asp.& biopsy
showed infiltration by malignant cells no megacariocytes.

Medical History:
breast lumps bilaterally invistigateg in perpheral hospital and reassured (benign).


Past surgical history:
no

Allergies:
no

Medications:
prednisolone 50 mg

Family history:
no

Social history:
married and has 4 kids


Physical Exam
General:
well . PERFORMANCE = 0






Temperature:
37 DEGREE CELSEUS

Heart rate:
85 Pulse/Minute

Blood pressure:
120/80

Respiratory rate:
20

Oxygen saturation:
98% on Room Air

Head, ears, eyes, nose & throat:
moon face BUT no butterfly , discoid lupus,OR mouth ulcers.

Neck:
no LN enlargement

Chest:
BILATERAL BREAST MASSES WITH PEUDORANGE AND RETRACTED NIPPLE NO DISCHARGE

Cardiovascular:
NORMAL HEART SOUNDS

Abdomen:
no hepatosleenomegally or abd masses

GU:
NORMAL

Rectal:
NORMAL

Neurological:
CONCIOUS ORIENTED NO CRANIAL NERVE PALSY
normal power , sensation , coordination.

Skin:
ecchymosis allover skin and piticheal RASH

Laboratories:
WBC 4.1 hg 98 g/l MCV 80 COOMBS( -ve ) platelets less than 10.
NORMAL RENAL , LIVER FUNCTION.
NORMAL C3 , C4 . ESR = 21 CRP (-VE)
Anti DNA = (-VE) , ANA = (+VE) 1 IN 160

Radiology:
dense breast tissue in mammography. ct chest abdomen and pelvis normal apart of breast masses. no axillary LN.

Other:
tumour markers all normal.

Pathology:
malignant infiltration of bone marrow.
FNA inconclusive.
TRUCUT biopsy :only fibrasis.
breast execion biopsy : malignant infiltration
ER , PR ,Her2 all negative.

Problems:
severe thrmbocytopenia with breast cancer, how to deliver chemotherapy and what to give?

Assessment:
diffcult case for management?

Plan of treatment:
weekly chemotherapy with Taxol / cisplatin

Results of treatment:
recovery of platelets count to 45 .
breast lumps softer.
but presentd to ER with epistaxis and wheeses.
more staines on pathology slides showed chromogranin positvity: suggest carcinoid tumour.

Discussion:
though thrombocytopenia is common in SLE due to consumption , but other causes is to be kept on mind and bone marrow biobsy is mandatory before commencingany ANY treatement modalities.

Pearls:
carcinoid syndrome appears after recovery of platelets as serotinin stored in platelets.




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