P1105 - Congestive Hepatopathy Masquerading as Gastrointestinal Malignancy

Sarah Dwyer Holland, MD, MS¹, Daniel Marino, MD, MBA¹, Michelle H. Kwon, MD², Julio Blasco Jimenez, MD³, Li Wang, MD^1
1Brown University, Providence, RI; ²Warren Alpert Medical School of Brown University, Providence, RI; ³Brown Medicine, Providence, RI

Introduction: Workup for mild hyperbilirubinemia requires a broad differential including liver disease, hemolysis, and malignancy. We present a case of a patient with hyperbilirubinemia, fatigue, and significant weight loss concerning initially for malignancy.

Case Description/Methods: A 79-year-old female with a history of complete heart block post cardiac pacemaker, heart failure with preserved ejection fraction, and iron deficiency had a one-year history of 45-pound weight loss, postprandial right upper quadrant pain, and failure to thrive. On admission to the hospital, her labs were significant for a bilirubin of 4 with direct bilirubin of 1.3 with otherwise normal liver function tests.

She was noted to have giant jugular C-V waves concerning for tricuspid regurgitation as well as signs of hypervolemia, and she was diuresed. Further workup with magnetic resonance cholangiopancreatography showed no biliary obstruction or ductal dilation. Echocardiogram showed dilated right ventricle with tethering and leaflet impingement from pacer wire with severe tricuspid regurgitation. Her pacemaker was subsequently replaced with a leadless pacemaker. Her presenting symptoms and hyperbilirubinemia began improving within one week, and her findings were subsequently attributed to congestive hepatopathy.

Discussion: We present a case of subacute tricuspid regurgitation and congestive hepatopathy in the setting of tricuspid leaflet impingement by pacer wire with associated weight loss and hyperbilirubinemia. It is important for gastroenterologists to maintain a broad differential including extra-gastroenterological etiologies during the workup of hyperbilirubinemia and weight loss.



Disclosures:


Sarah Dwyer Holland, MD, MS¹, Daniel Marino, MD, MBA¹, Michelle H. Kwon, MD², Julio Blasco Jimenez, MD³, Li Wang, MD¹. P1105 - Congestive Hepatopathy Masquerading as Gastrointestinal Malignancy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.