Cholestatic hepatitis has not been reported as a paraneoplastic syndrome of endometrial adenocarcinoma to our knowledge. We present a patient who, shortly after endometrial adenocarcinoma diagnosis, presented with elevated liver chemistries in the setting of an acute, paraneoplastic sensorimotor polyneuropathy. Infectious, autoimmune, pharmacologic, malignant, metabolic, and structural causes of cholestatic hepatitis were screened for and ruled out. Our patient was diagnosed with simultaneous cholestatic hepatitis and acute sensorimotor polyneuropathy as possible paraneoplastic syndromes of endometrial adenocarcinoma. Clinicians should include paraneoplastic processes of cancer in the differential diagnosis for liver injury, especially when workup for alternative causes is unrevealing.

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INTRODUCTION: Inflammatory bowel disease (IBD) patients have increased venous thromboembolism (VTE) risk and commonly have iron deficiency anemia (IDA) and anemia of chronic inflammation (ACI). Anemia can signal increased inflammation and disease severity in IBD patients. Pro-inflammatory diseases, like IBD, and IDA have been independently associated with VTE. VTE chemoprophylaxis is sometimes withheld in hospitalized IBD patients with minor rectal bleeding or severe disease due to safety concerns. This study aimed to assess the impact of anemia on VTE, in-hospital mortality, and length of hospital stay in hospitalized IBD patients. METHODS: Using the Nationwide Inpatient Sample database, a cross-sectional analysis was performed of hospitalized IBD patients between 2008 and 2014 aged ≥18 years stratified by VTE diagnosis based on ICD-9 code. Multivariate hierarchical logistic regression analyses were performed to evaluate the impact of IDA and ACI on VTE and short-term outcomes. RESULTS: Of 434,834 hospitalized IBD patients, 2.8% had diagnosis of VTE. Characteristics of hospitalized IBD patients are described (Table 1). ACI and IDA were independently associated with VTE in IBD patients. In a subgroup analysis using a multivariate hierarchical logistic regression model, IBD patients with IDA had higher odds of VTE (OR, 1.35; 95% CI, 1.27–1.43), deep vein thrombosis (OR, 1.36; 95% CI, 1.27–1.46), and pulmonary embolism (OR, 1.40; 95% CI, 1.27–1.54). IBD patients with ACI also had higher odds of VTE (OR, 1.28; 95% CI, 1.20–1.37) and deep vein thrombosis (OR, 1.42; 95% CI, 1.32–1.53), but not pulmonary embolism (OR, 0.94; 95% CI, 0.83–1.05). Higher odds of in-hospital mortality were seen in IBD patients with IDA (OR, 2.03; 95% CI, 1.82–2.28) and ACI (OR, 1.43; 95% CI, 1.30-1.58). Prolonged hospitalization was also more common in IBD patients with IDA (OR, 1.36; 95% CI, 1.33-1.40) and ACI (OR, 1.54; 95% CI, 1.49-1.59) (Table 2). CONCLUSION: The presence of anemia due to IDA and ACI independently predicts the occurrence of VTE, prolonged hospitalization, and in-hospital mortality in hospitalized IBD patients. Higher odds of in-hospital mortality and prolonged hospitalization suggests increased disease severity among hospitalized IBD patients with anemia. Providers should adhere to VTE chemoprophylaxis guidelines for hospitalized IBD patients, including those with severe disease or minor rectal bleeding, to mitigate VTE risk.

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