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Washington University Experience | INFECTION | Bacteria | TB - Individual Case | 1A0 Case 1 History
Case 1 History ---- The patient was an 89 year old woman with a history of hypertension, weight loss, decreased appetite, and fatigue. A CT scan showed multiloculated cystic masses in the pancreas (1.8 x 1.4 cm), liver (2.9 x 2.4 cm) and duodenum (1.0 cm). She declined invasive diagnostic procedures and was scheduled to follow-up with an abdominal MRI several months later. Prior to that scheduled date, she was found on the floor at home and was confused and lethargic. At the ER a CT scan of the head showed no acute intracranial process and there was no acute cardiopulmonary disease by chest X-ray. However, a CT scan done a few days later showed a right subdural hematoma which caused leftward midline shift. The patient subsequently underwent emergency craniotomy. The day following, the patient became tachycardic and hypertensive. A chest CT showed diffuse ground glass opacities in bilateral lungs. A PPD test was negative. The patient's neurologic status remained stable over the next several days. However, she developed a fever at which time CXR showed diffuse nodular interstitial opacities in the lungs in a miliary pattern. The patient was started on cefepime and azithromycin for a clinical concern of pneumonia. Blood samples taken over the next few days had no growth on culture. The patient was at that time afebrile, had waxing-and-waning mental status issues and had increased respiratory distress on room air. Abdominal MR showed stable multiloculated pancreatic and liver lesions. Bronchoscopy and sputum induction for acid fast test or culture were declined by the patient’s family. Head CT taken on 4/19/10 showed a stable small evolving right hematoma. The patient became unresponsive and had increased respiratory distress. Due to the patient's worsening condition, the family changed the patient's status to be DNR/DNI. She was on respiratory isolation prior to her death and she expired.
