Endocrine Abstracts

Patient is a seventy year old Egyptian female with past medical history of coronary artery disease, systolic heart failure, chronic kidney disease stage 3, and a benign pheochromocytoma previously worked up at a neighboring hospital, who was admitted for dyspnea and subjective fever intermittently for the past two weeks. Chest x-ray revealed bilateral pulmonary infiltrates. She was treated for community acquired pneumonia. Four days after admission patient has worsening respiratory distress with fever, leukocytosis, tachypnea and was intubated and transferred to ICU. Pan cultures obtained on admission returned negative and her symptoms resolved two days later. Patient’s antibiotics were de-escalated and patient was then discharged home. It was thought that her sepsis was likely secondary to pneumonia resulting in acute hypoxic respiratory failure. Patient returned four days later and was readmitted directly to the ICU for worsening dyspnea with a temperature of 102.0, leukocytosis of 27.4, heart rate of 149, respiratory rate of 30, with a blood pressure of 172/90 and pulse oximetry of 83%. Chest x-ray revealed new bilateral infiltrates from previous admission. Patient was intubated and treated with Zosyn, vancomycin, and gentamycin. Cultures again were obtained and again returned negative. It was then thought after researching similar cases that the patient’s pheochromocytoma could be leading to a “pseudo” septic picture. It was then determined that patient’s septic symptoms were likely due to pheochromocytoma as patient’s blood pressure would coincide with febrile episodes and dyspnea. Patient was placed on prazosin and blood pressure normalized during admission without return of fever. Pheochromocytoma should be considered as part of the differential diagnosis in the setting of recurrent dyspnea and sepsis when more common causes have been ruled out. It is also important to do this early as to prevent unnecessary antibiotic use and to prevent antibiotic resistance.