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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Brainstem & Cerebellum | 17A0 Case 17 History
Case 17 History ---- The patient was a 73 year old man with a history of multiple sclerosis (x30 yrs), chronic and recurrent UTI, polio at age 26 years, situs inversus totalis, and chronic constipation. He presented to the ER in mid-December 1994 with a 48 hour history of shortness of breath and tachypnea, thought to follow aspiration. Chest x-ray revealed left lower lobe infiltrates vs. atelectasis, patchy infiltrates in the right lung field, and large left diaphragmatic hernia. ABG on 2 liters of O2=7.39/54/65. Sputum analysis revealed 3+ WBC, 2+ gram positive bacilli, 4+ gram positive cocci in clusters, and 4+ gram positive cocci in pairs and chains. The patient was given 1 gm IV ceftriaxone in the ER and admitted to the ward. Physical examination on admission showed vital signs of: temperature 38.8 C, P 140/min, RR 32/min, and BP 140/70 mmHg. Decreased breath sounds were noted on the left side, and decubitus ulcers were present over the sacrum, right thigh, and leg. Laboratory findings revealed remarkable leukocytosis with neutrophilia (WBC=20.8K, N=84%), mild anemia (Hb 7.2), and thrombocytosis (platelet 961K). Also noted were hyperglycemia (glucose 263), urine WBC positive 30/HPF with numerous bacteria, and normal liver function tests. The first impression was aspiration pneumonia. He was placed on Clindamycin, Iron sulfate, Calcium carbonate and Klonopin. During his hospitalization he continued to have spiking fevers despite aggressive antibiotic treatment. On 12/20/94 the patient complained of "not feeling well". Sputum culture at that time showed moderate beta-hemolytic streptococci. WBC decreased to 12.9K. In mid December 1994 he was found to be unresponsive with no spontaneous respirations, no pulse, and pupils were fixed.
