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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Cerebral Hemispheres | 4A0 Case 4 History
Case 4 History ---- The patient was a 54 year-old woman with long standing history of multiple sclerosis, end stage, who expired after a bout of pneumonia. Multiple sclerosis was diagnosed in 1981 with symptoms predating that initial diagnosis by several years. It is unclear how she was managed in this twenty year span, but was reported to have been on "several different medications". She had become non-verbal, but was able to make eye-contact and still interacted with her family. She was cachectic and weighed only 55 lbs. She was non-ambulatory and had a suprapubic catheter. She had a very weak cough. Before the most recent admission, she had developed another cough and was initially treated with Cipro. She later presented to her local hospital with a weak but productive wet cough and fever >101oF. She was noted to have an "extensive" left lower lobe pneumonia. Blood cultures were negative. Her sputum grew Candida albicans. Her urine cultures showed large quantities of mixed organisms including Klebsiella pneumoniae, E. Coli, and Enterococcus faecalis. She had leukocytosis with a neutrophil predominance. She was treated aggressively with multiple antibiotics and pulmonary toiletry and made a modest recovery before she was taken home by her family on antibiotics and oxygen. The patient expired in January, 2003.
