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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | AHL | AHL | 1A0 Case 1 History
Case 1 History ---- The patient was a 19 year old woman without a significant past medical history who had been part of a cleaning detail without a respirator. The next day, she experienced decreased appetite and malaise and subsequently vomiting and complaining of serious abdominal pain. She developed ataxia, sleep disturbances, followed by personality changes and headaches. Work-up at an outside hospital included an MRI that showed white matter brain lesions. A chest CT showed innumerable nodules. She underwent thorascopic biopsy that showed perivascular chronic inflammation and granulomatous inflammation. She was treated with high dose steroids for presumed sarcoidosis. The patient was discharged with slight improvement in her symptoms. She continued to have behavioral and memory problems and was brought to our hospital. Lumbar puncture was notable for 22 nucleated cells (98% lymphocytes), glucose of 64 and protein of 44. An erythrocyte sedimentation rate was 23, serum autoantibodies and antibodies for HIV were negative. CSF cytology was suspicious for a hematolymphoid process. Flow cytometry on a CSF specimen showed degenerated cells with a few small benign mature lymphocytes. The patient became acutely unresponsive. She was only transiently hypoxic, maintained a pulse throughout the entire event, and was intubated for airway protection. She was transferred to the Neurological ICU but the next morning she had become brain dead. The entire course of her illness was shortly more than two months.
