Endocrine Abstracts

A 58-year-old gentlemen presented with severe neckache, sweating, feeling hot, and cold. PMH included hypertension and MI. On examination, he was clammy, with blood pressure (BP) 205/107 mmHg. Laboratory results showed leucocytosis 28.5 and TroponinT 2002 ng/l (reference range <14.0). ECG showed inferolateral ST depression. CT angiogram showed a normal aorta and a 6 cm right adrenal mass. An echocardiogram showed severe LV impairment and normal valves.

Phenoxybenzamine, nitrates, diuretics and digoxin were commenced. After 2 days, the patient developed fever (38.5 °C), acute kidney injury, hyponatraemia and a DIC-like picture. Intravenous fluids and antibiotics were given for suspected sepsis. Capnocytophaga canimorsus rods were later grown from blood cultures and the patient recollected that he had recently been bitten by a dog. Following treatment, the patient made a full recovery with subsequent normalisation of BP. Urinary collections for adrenaline, noradrenaline and metanephrine showed values of 40 763, 30 378, and 142.6, respectively (upper reference ranges 490, 93 nmol/24 h and 1.7 μmol/24 h). Coronary angiography confirmed two vessel disease. Surprisingly, TTE performed about a week after admission showed normalisation of LV function. The patient underwent laparoscopic right adrenalectomy and is currently well.

Background: TakoTsubo cardiomyopathy (broken heart) is a condition characterised by transient systolic dysfunction. It appears to relate to contraction abnormalities secondary to increased levels of stress hormones. Clinical and ECG presentations resemble ACS.

Capnocytophaga canimorsus are anaerobic, gram-negative rods present in the oral flora of canines. Only about 200 cases of human infection have been reported worldwide. In humans, Capnocytophaga can cause fatal sepsis and DIC with increased mortality rate.

In summary, we describe a unique case of the patient with phaeochromocytoma crisis accompanied by transient severe LV dysfunction and features of ACS, which could be a part of TakoTsubo cardiomyopathy, who developed life-threatening Capnocytophaga canimorsus sepsis, following a dog bite.