A47-35 The Rare Case of High Amylase Levels Found in a Pleural Effusion

Abstract The knowledge we have on the congruence of high amylase levels associated with pathologies is quite limited at this time. Up until recently, high amylase levels in pleural effusions were found only to be associated in cases of malignancy. This lack of data was in part due to the clinical utility of the measurement of amylase levels in pleural effusions. A 65 year old female with past medical history of hypertension, alcoholic pancreatitis, hiatal hernia s/p repair was admitted due to concern for severe abdominal pain with nausea and vomiting. Upon arrival at the hospital she was found to be in atrial fibrillation with rapid ventricular rate, WBC 17.9, K 2.4, Mg 0.8, Na 131, lactic acid 11.27, troponin 62, bicarbonate 9.4. Initiation of IV Vancomycin, IV Zosyn, 1250 mL NS, 80 mg protonix, 2 G mag, 40 mEq K C was started. She was started on neo-synephrine and admitted to ICU for further management of septic shock. CT chest revealed pneumothorax along the anterior right hemithorax seen measuring less than 10% and moderate right pleural effusion. Due to the high suspicion for empyema, a right-sided chest tube was placed, which drained over 900mL of purulent effusion. Upon analysis of pleural fluid it was found to be exudative with amylase level 2526 and cytology negative for malignant cells, fungal negative, ADA 9, and segmented neutrophils body fluid % 93. Due to the high amylase levels detected it was imperative for the patient to undergo esophagogastroduodenoscopy which identified a perforation that required stent and nasogastric tube placement. Progressive complexity in her hospital course was accompanied by her worsening respiratory status, which ultimately proved fatal. The occurrence of high amylase levels in pleural effusions has been found to be rarely associated with malignant pleural effusions, pancreatitis or esophageal ruptures. With time if more cases which are able to correlate high amylase levels with pathologies are identified, there would be clinical relevance in obtaining such data which was once not encouraged. Reportedly elevated pleural fluid amylase levels have been found to be increasingly useful in establishing the diagnosis of malignancy, pancreatitis, or esophageal rupture. The ability to detect pathologies associated with high amylase levels may help prevent the associated morbidity and mortality. This abstract is funded by: None