Urinothorax is a rare cause of pleural effusion. Infected urinothorax is even rarer. Here we present a case of infected urinothorax from renal mass causing obstructive uropathy. Patient improved with pleural drainage and a multidisciplinary approach of treatment between team involving urologist and pulmonologist. This case highlights the complexity in the diagnosis and management of infected urinothorax.

SESSION TITLE: Cardiovascular Disease Posters 3 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Vascular damage from inflammation in ANCA vasculitis leads to a sustained procoagulant state causing accelerated atherosclerosis. A population-based cohort study found that the risk of cardiovascular disease is more than 3-fold higher in patients with ANCA-associated vasculitis. We hypothesize that those with ANCA vasculitis are more likely to have a major adverse cardiovascular event compared to those in the hypertension control group. Our aim was to determine associations of major adverse cardiovascular events (MACE) in patients with history of ANCA-associated vasculitis compared to that seen in the control group, patients with hypertension without ANCA-associated vasculitis. METHODS: We retrospectively reviewed patients with ANCA vasculitis (n=125) between 2017-2020. Charts were reviewed to assess cardiovascular (CV) risk factors which included history of smoking, hypertension, hyperlipidemia, diabetes mellitus and chronic kidney disease. Incidence of MACE such as myocardial infarction (MI), stroke, heart failure (HF) was calculated retrospectively after the diagnosis of ANCA vasculitis. Chi square and modified Poisson regression were used to calculate the incidence rate ratio (IRR) for MACE. We also retrospectively reviewed patients with hypertension without ANCA-associated vasculitis (n=100) between 2017-2020. The associations of each of the ANCA vasculitis categories and hypertension group with outcomes of MACE were examined by logistic regression. Minitab statistical software was used with significance accepted at p <0.05. RESULTS: Of 125 total ANCA vasculitis patients, 77 (61.6%) had granulomatosis with polyangiitis (GPA), 37 (29.6%) had eosinophilic granulomatosis with polyangiitis (EGPA), and 11 (8.8%) had microscopic polyangiitis (MPA). Females were 68%. Mean age of the cohort was 58 years with a mean BMI of 29.4 kg/m². The unadjusted and adjusted (for age, gender, and CV risk factors) IRR for stroke was significantly lower in patients with EGPA and MPA vs. GPA (p<0.05), while IRR for HF was higher in EGPA vs. GPA (p<0.05). The adjusted IRRs for MI and HF were higher in patients with EGPA and MPA but were not statistically significant. The mean age of the hypertension group was 62 years with a mean BMI of 30.1 kg/m². Females were 48%. The odds of having a stroke were higher amongst EGPA, GPA, and MPA patients than hypertension patients. The odds of having a MI were higher amongst EGPA, GPA, and MPA patients than hypertension patients. The odds of having HF were higher amongst EGPA and GPA patients than hypertension patients. The odds of having HF were higher amongst MPA patients than hypertension patients but were not statistically significant. CONCLUSIONS: Incidence of stroke is higher in GPA patients compared with EGPA and MPA, while EGPA patients are more likely to have heart failure compared to GPA patients. The odds of having a stroke and MI were higher amongst EGPA, GPA, and MPA patients than hypertension patients. The odds of having HF were higher amongst EGPA and GPA patients than hypertension patients. CLINICAL IMPLICATIONS: Patients with ANCA-associated vasculitis are at increased risk of major adverse cardiovascular events. DISCLOSURES: No relevant relationships by Moiz Ehtesham No relevant relationships by Larabe Farrukh No relevant relationships by Shannon Murawski No relevant relationships by Ruben Peredo-Wende No relevant relationships by Lisa Rosenberg

SESSION TITLE: Lung Cancer Case Report Posters 13 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Palmar fasciitis and polyarthritis syndrome (PFPA) is rare and consists of painful symmetrical swelling and finger flexion contractures with associated vascular motor instability, mimicking complex regional pain syndrome (1). The most pertinent feature of PFPA is its association with underlying malignancies (2). Reported evidence highlights PFPA to be associated with advanced or metastatic malignancies. We present a case of PFPA in association with early detection of pulmonary adenocarcinoma. CASE PRESENTATION: A 68-year-old man presented with sudden onset of bilateral hand swelling involving the fingers and wrists. He was a former 45-pack–year smoker, quit 30 years ago. He had a history of treated papillary thyroid carcinoma and a right hemidiaphragm paralysis secondary to pacemaker placement. Lung exam revealed vesicular breath sounds without adventitious sounds. On musculoskeletal examination, there was diffuse symmetrical dorsal edema with inability to stretch the 3rd to 5th digits of both hands. Laboratory values showed a C-reactive protein of 2.4 mg/dL (0.8) and normal serum uric acid. Additionally, ANA, anti-CCP antibodies, rheumatoid factor, and HLA-B27 were all negative. He was diagnosed with seronegative inflammatory polyarthritis and was started on a prednisone taper followed by weekly oral methotrexate. His swelling subsided 2 months later, however flexion contractures in the 3rd to 5th digits of both hands persisted despite a full course of Occupational Therapy. Based on the refractoriness of his symptoms to conventional therapies for arthritis, alternative diagnoses were entertained, including PFPA secondary to underlying malignancy. Noting the significant history of smoking and thyroid carcinoma, he underwent a low-dose chest CT. Radiographic findings were significant for a spiculated irregular 1.7 x 1.0 cm nodule of the left lung apex. A follow-up full body PET/CT scan showed increased uptake in the left upper lung but no evidence of regional or distant metastatic disease. Pathology results following biopsy revealed moderately differentiated invasive adenocarcinoma. Given his comorbid right-sided diaphragmatic paralysis and early stage of the disease, he received stereotactic body radiation therapy (SBRT). DISCUSSION: The US Preventive Services Task Force guidelines for lung carcinoma screening recommend the evaluation of individuals ages 50 to 80 who have a 20 pack-year smoking history and are currently smoking or who have quit within the past 15 years. Our patient did not fulfill these criteria and by these guidelines the low-dose chest CT was not indicated. However, screening for malignancy should extend to patients with additional clinical suspicion, as in our patient who had a history of prior malignancy, smoking, and poor response to conventional therapies for arthritis. Prompt identification of these features led to an early diagnosis of pulmonary adenocarcinoma. The literature had previously associated PFPA with advanced or metastatic malignancies. Thus, this is a unique case in which the presence of PFPA led to an otherwise unprompted diagnosis of early-stage malignancy. CONCLUSIONS: Recognition of PFPA should prompt screening patients for age-related malignancy, aimed at achieving an early detection and avoidance of progression to metastatic disease. Flexion contractures from PFPA are usually resistant to treatment but are more likely to resolve with treatment of an underling malignancy (3). REFERENCE #1: Manger B, Schett G. Palmar fasciitis and polyarthritis syndrome-systematic literature review of 100 cases. Semin Arthritis Rheum. 2014;44(1):105-11. REFERENCE #2: Okumura H, Ishino H, Yokoi D, Matsumura M. Palmar Fasciitis and Polyarthritis Syndrome Associated with Lung Adenocarcinoma. Intern Med. 2022;61(14):2221-5. REFERENCE #3: Strunz PP, Schmalzing M. [Paraneoplastic syndromes in rheumatology]. Z Rheumatol. 2023. DISCLOSURES: No relevant relationships by Larabe Farrukh No relevant relationships by Simrin Kooner No relevant relationships by Ruben Peredo-Wende No relevant relationships by Lisa Rosenberg No relevant relationships by Sumbal Wajid