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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Schwannian CNS remyelination | 2A0 Case 2 History
Case 2 History ---- The patient was a 45 year old woman with a history of multiple sclerosis. Since her diagnosis in 1989, she had been treated intermittently with Solumedrol. Upon her admission to our hospital she was quadriplegic, incontinent, blind, and without a gag reflex, all secondary to MS. She was able to communicate by moving her head, eyes, and mouth. She was morbidly obese secondary to insatiety, thought to be due to hypothalamic disease. She had baseline respiratory impairment necessitating the use of home oxygen therapy. She was transferred from an outside hospital in late October 1996 due to respiratory failure and new onset of seizures. Upon admission she had a normal head CT scan, and her tonic-clonic seizures were considered secondary to hypercarbia, hypokalemia, and/or hypomagnesemia; they were well controlled with Dilantin and Ativan. Her hospital course was notable for several episodes marked by hypotension, bradycardia, and hypoxemia, for which she was transferred to the intensive care unit on those occasions. Sepsis was considered a possible etiology, although all her blood cultures were negative. She had recurrent urinary tract infections due to an indwelling Foley catheter. On admission her urine grew Klebsiella and E. coli, and, later in her hospitalization, Enterococci and yeast. In addition, there was some concern for pneumonia due to the possibility of sepsis and an equivocal pulmonary radiologic picture. Both the urinary tract infection and pneumonia were treated with antibiotics. Her final week of life was marked by a decrease in mental status and she expired.
