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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Brainstem & Cerebellum | 13A0 Case 13 History
Case 13 History ---- The patient was a 39 year old female with multiple sclerosis and morbid obesity (status-post laparoscopic gastric bypass 11/8/00). She had multiple hospital admissions since 12/00 for complications of her gastric bypass surgery. She was quadriplegic and had been wheelchair bound for several years due to her multiple sclerosis. In July 2001 she experienced onset of jaundice and change in mental status. Her admission labs were significant for abnormal liver function tests (total bilirubin=9.8, ammonia=95, SGOT=87, alkaline phosphatase=124, prothrombin time=16-18, ferritin=1000, iron saturation=63%, and albumin=1.4). She had no prior history of liver disease and the liver appeared normal during her gastric bypass surgery. During her admission, a liver biopsy showed chronic active hepatitis with marked steatosis (grade 3, stage 2) with no increase in stainable iron and no significant copper. She also had negative viral hepatitis serologies, was ANA negative, and was anti-mitochondrial antibody negative. She was found to have a ceruloplasmin of 18, increased MCV of 102, and normal folate and B12 levels. The patient's hospital course was complicated by dehiscence of her midline vertical incision, hypokalemia, and poor oral intake. The patient died at the end of August 2001 from hepatic failure.
