SESSION TITLE: Critical Care Complications SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/22/2019 3:45 PM - 4:45 PM INTRODUCTION: Pseudocirrhosis is an uncommon complication seen in breast cancer patients with liver metastasis who are treated with chemotherapy. It resembles both the clinical presentation and radiologic imaging of cirrhosis and can result in portal hypertension and hepatic failure. Pseudocirrhosis develops in response to the chemotherapeutic effects on hepatic masses leading to hepatocellular injury and is associated with a high mortality with most patients dying within weeks to months from liver failure or complications of portal hypertension. Described below is a case of a patient who developed hepatic encephalopathy secondary to pseudocirrhosis following treatment with Paclitaxel, Trastuzumab, and Pertuzumab. CASE PRESENTATION: A 43-year-old female with metastatic breast cancer to the liver treated with bilateral mastectomy, radiation therapy, and multiple chemotherapy treatments as well as thyroid cancer status post thyroidectomy presented to the emergency department with encephalopathy and right lower extremity twitching. On physical exam, she was minimally responsive with jaundice, scleral icterus, and abdominal distension. She was emergently intubated for airway protection. Her labs were significant for a transaminitis, hyperammonemia, hyperbilirubinemia, and prolonged prothrombin time. She had a computed tomography scan of her abdomen and pelvis and when compared with her prior scan two weeks before admission, it revealed interval development of a nodular heterogeneous liver concerning for pseudocirrhosis along with bilateral pleural effusions and ascites. Blood cultures, Hepatitis B and C, and Anti-nuclear, Anti-smooth muscle, and Anti-mitochondrial antibodies were negative. Her family denied that she had any regular alcohol consumption. She was given lactulose, rifaximin, and vitamin K with improvement in her mental status and was successfully extubated. DISCUSSION: The etiology of altered mental status can be difficult to establish with it frequently being attributed to metabolic derangements, stroke, or delirium. Although a rare diagnosis, it is important to recognize pseudocirrhosis may be the cause of encephalopathy in a patient with liver metastases who has received chemotherapy. Checking ammonia levels may be helpful in diagnosis. Treatment is similar to classic hepatic encephalopathy by eliminating nitrogenous waste products with lactulose and/or rifaximin. CONCLUSIONS: Early diagnosis of pseudocirrhosis in patients with metastatic breast cancer who are treated with chemotherapy is essential to begin appropriate treatment to avoid the complications of cirrhosis. Reference #1: Adike A, Karlin N, Menias C, Carey EJ. Pseudocirrhosis: A Case Series and Literature Review. Case Rep Gastroenterol. 2016;10(2):381-391. Published 2016 Jul 29. https://doi.org/10.1159/000448066 DISCLOSURES: No relevant relationships by Nathan Brewster, source=Web Response No relevant relationships by Brian Civic, source=Web Response No relevant relationships by Kareem Godil, source=Web Response No relevant relationships by Brian Holahan, source=Web Response No relevant relationships by Alaynna Kears, source=Web Response