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Washington University Experience | MUSCLE | Myosin Loss Myopathy | 3A0 Case 3 History
Case 3 History ---- The patient is a 72 year-old, female transferred from an outside hospital 6 weeks previously with an admission diagnosis of generalized weakness thought to be due to steroid induced myopathy. She presented with mental status changes, generalized weakness, and fever. The clinical picture was most consistent with pneumonia and she was treated with empiric antibiotics. She had some cardiopulmonary issues, including atrial tachycardia which prompted a transfer to a progressive care unit and subsequent respiratory failure associated with bradycardia that prompted intubation. She was started on intravenous Solu-Medrol for pulmonary issues. She had grown Stenotrophomonas from her trach and also had a history of chronic obstructive pulmonary disease. She had multiple extubation attempts which were unsuccessful and she eventually underwent tracheostomy. She also had alternating tachycardia and bradycardia with her atrial arrhythmia and underwent pacemaker placement. She had been sedated for much of her hospital course with Propofol, but when sedation was weaned she was noted to have diminished strength (2/5) in all four extremities. She had some fluctuations in her motor performance she developed persistent weakness. Neurology consultation was obtained at the outside hospital and they suspected critical care myopathy. Transfer to Barnes Hospital Neurology Service for further workup was requested as electromyelogram and nerve conduction studies were not available at their facility.
