Here - American Geriatrics Society

P OSTER
A BSTRACTS
Methods: We are conducting a 6-week, randomized, 3-arm clinical
trial to compare the efficacy of 2 tailored, multi-component exercise
programs for improving physical performance of older PCa patients
on ADT. Men, aged 70 and older, were randomly assigned to
either an established progressive resistance and walking program
(EXCAP), a similar home-based computer-generated exercise program
utilizing Nintendo’s Wii-Fit technology (Wii), or a usual care
arm (UC). Assessments were completed at baseline and post-intervention.
Primary outcome was a comparison of change scores on the
Short Physical Performance Battery (SPPB) (0-12). Secondary outcomes
were comparisons of changes in lean muscle mass (DEXA),
chest press repetition maximum (CPRM), handgrip strength (HG),
and total body weigh (TBW). T-tests were used to compare change
scores between arms.
Results: Sixteen (of 30 projected) men have completed post-intervention
assessments (7 in Wii, 4 in EXCAP, and 5 in UC). The
mean age of participants at enrollment was 76.9 years (70-87) and
mean SPPB score was 7.6 (4-11). Mean duration of ADT was 57
months. Mean SPPB scores improved by 1.25 in Wii vs UC (p=0.054),
while mean scores improved by 1.33 in Wii vs EXCAP (p=0.061).
There was no significant difference in change of scores between
EXCAP and UC (p=0.903). Mean total body weight decreased by 4
kg in Wii vs UC (p=0.092) and mean handgrip strength increased by
4.37 kg in Wii vs UC (p=0.0274), and mean CPRM increased by 12.9
reps in Wii vs UC (p=0.092). Lean muscle mass improved by 820
grams in Wii compared to UC, although this was not statistically significant
(p=0.42).
Conclusions: Change scores were improved in all measures for
Wii arm, while there were no changes in UC arm. This pilot study
demonstrates the potential of Wii Fit technology to improve physical
performance in older men on ADT over 6 weeks.
B4
REDD in the elderly.
A. Chakka, A. Garrido, T. Iloabuchi, F. Perez. Geriatrics, Indiana
University, Indianapolis, IN.
81 y/o AAF with h/o Dementia, HTN, Gout, Hypothyroidism,
DVT s/p IVC filter and GI bleed was admitted for decreased PO intake
and weakness. She had B/L leg pain and progressive edema. Patient
was only on Levothyroxine as all her medications were stopped
for drug induced hepatitis. On exam- lethargy; Tmax-39.4’ C, BP-
76/40, HR-94. Oral mucous membrane hyperemia; RS- clear; CVS-
RRR; ABD- soft, BS+; CNS- confusion; BLE- 2+ edema; Skin- diffuse
macular erythema. Labs: Wbc- 11.5, Eos- 15, Pl.let- 29, BUN/Cr-
25/1.39 (baseline cr- 0.49), UC+ staph.aureus, BC+ MSSA. TEE, CT
chest/abdomen, and vasculitis work up were negative. Patient was admitted
to ICU with sepsis and treated with cephazolin for 3 weeks.
Patient was stable in a week, erythema resolved but a week later developed
generalized desquamation involving palms and soles with
itching, which resolved in 2 weeks. Ten days later she was re-admitted
for abdominal pain, hypotension and hypothermia. She had a similar
clinical picture associated with myositis and the same diffuse erythema
followed by diffuse desquamation, which continued over 4
weeks till she was discharged.
DISCUSSION:
The Differential Diagnosis consisted of Staphylococcal Toxic
shock syndrome (TSS), Stevens - Johnson syndrome, Toxic Epidermal
Necrolysis, Kawasaki disease, Mercury Poisoning and Syphilis. Patient
was diagnosed with a TSS variant, recalcitrant erythematous
desquamating disorder (REDD)[1]. It is a toxin-mediated illness[2],
usually precipitated by infection with Staphylococcus aureus. REDD
is a presumed variant of TSS and is distinguished from classic TSS by
its subacute presentation and recalcitrant course. Although the majority
of patients described to date have had acquired immunodeficiency
syndrome (AIDS), some cases without AIDS have been reported.
Our patient did not have any risk factors for HIV. The
diagnostic criteria met by our case are: Temp > 38.9 ‘C, SBP < 90
mmHg, Diffuse macular erythema with subsequent desquamation involving
palms and soles and multiorgan involvement. To our knowledge
this is the first case report of REDD in an elderly patient.
REFERENCES:
1. Verbon, A. and C.J. Fisher, Jr., Severe recalcitrant erythematous
desquamating disorder associated with fatal recurrent toxic
shock syndrome in a patient without AIDS. Clin Infect Dis, 1997.
24(6): p. 1274-5.
2. Manders, S.M.,Toxin-mediated streptococcal and staphylococcal
disease. J Am Acad Dermatol, 1998. 39(3): p. 383-98; quiz 399-400.
B5
Fever of Unknown Origin in women with osteoporosis.
B. Peddagovindu, E. Oleson, C. DuBeau. Geriatrics, UMass Med
School, Worcester, MA.
Introduction:
Recognition of atypical presentation of disease and prescribing
cascades from adverse drug effects (ADEs) are tenets of geriatric
care. We present 2 cases of an ADE and the costly investigative cascade
that followed it due to non-recognition of the uncommon pattern
of the ADE.
Case 1:
A 63yo woman with osteoporosis, hypertension, diabetes,
COPD, pneumonitis and anxiety who was a poor historian was hospitalized
due to fever 101.3, malaise, myalgia, nausea/vomiting, cough
and dyspnea of one-day duration. Initial work up for infectious
causes was negative. She received zoledronic acid (ZA) for treatment
of osteoporosis 2 days prior, but it was not on her medication list and
not discovered until 5 days into her stay. She continued to have fevers
spikes to 101F and dyspnea. Empiric antibiotics for pneumonia were
given for 5 days and repeat fever work up was negative. She was discharged
after 1 week with diagnosis of fever from ZA ADE upon exclusion
of other causes.
Case 2:
A 71yo woman with history of non-hodgkin’s lymphoma, cirrhosis,
anxiety, osteoporosis, and nephrolithiasis was hospitalized due to
fever 101F, and nausea/vomiting 1 day after ZA infusion and discharged
in 24h after symptom control and negative infectious work
up. She then developed a rash on her neck thought to be shingles and
was given valcyclovir. She was seen by ID and given doxycycline for
suspected tick borne illness. Due to daily fevers to 101F and worsening
cough she was readmitted 12 days after original d/c. Per ID and
oncology, pertussis titers, serology for tick-borne illnesses and CT
chest/abdomen/pelvis for possible lymphoma recurrence done were
negative. After 20 days, diagnosis of exclusion of fever from ZA was
made. Total duration of fever was more than 20 days.
Discussion:
Fever is the most common ADE of ZA, likely from an increase
in TNF-a and IL-6. In cases presented, patients had extended hospital
stays and costly work ups because 1) ZA use was initially missed, and
2) duration of fever > 72 hrs (usual for this ADE), “atypical presentation”
of ZA ADEs, was not recognized. ZA fever may last 14+ days
with rash and cough. These cases demonstrate the need to keep ZA
on active med lists, understanding and informing patients about ZA
ADEs, and using careful follow-up rather than costly evaluations for
even prolonged fever after ZA. Prevention with acetaminophen or
ibuprofen following ZA infusion can decrease this common ADE.
B6
81 year old man hospitalized with hypercalcemia - of course its
cancer!
C. Hathaway, D. Bynum. Division of Geriatric Medicine and Center
for Aging and Health, University of North Carolina, Chapel Hill, NC.
Supported By: University of North Carolina Division of Geriatric
Medicine and Center for Aging and Health
Introduction: It is very unusual for patients in the geriatric population
to present with sarcoidosis as a new diagnosis, and thus there
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AGS 2012 ANNUAL MEETING