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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
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S156
P-263
Cryptogenic organizing pneumonia: a rare syndrome even
in the elderly. Case report
S. Zannoni
1
, C. Lorenzi
2
, M. Paoli
2
, F. Orso
3
, M. Torrini
4
,
M. Rafanelli
5
, G. Toffanello
5
, A. Giordano
6
, F.C. Gori Sacco
4
,
N. Marchionni
3
, A. Ungar
7
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 12.5mg / 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. Zulfiqar
1
, R. Mahdi
1
, J.-L. Pennaforte
1
, J.-L. Novella
2
,
E. Andres
3
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. Panek
1
, A. Martin-Kleisch
1
, L. Babe
1
, J.-L. Novella
2
, A.-A. Zulfiqar
1
1
CHU Reims, Reims, France;
2
France
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 266mg/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
b
2 microglobulin to 4.65mg/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.