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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Shadow Plaque | 5A0 Case 5 History
Case 5 History ---- This patient was a 33 year-old female with a history of multiple sclerosis diagnosed at 19 years of age. A few years prior to her death, she had visual acuity of 20/200 and 20/400 in the right and left eyes, respectively. She had upgaze nystagmus and dysarthria. Her motor exam was notable for a spastic quadriplegia. The treating physician felt that she had secondary progressive multiple sclerosis. MRI of the brain revealed extensive periventricular white matter lesions both supra- and infratentorial without active contrast enhancement and notable cerebral and cerebellar atrophy. She had been previously treated with mitoxantrone without benefit and interferon therapy was commenced without benefit. Her course was complicated by an unexpected pregnancy during which she developed gestational diabetes mellitus. Within two weeks after delivery of her child, she returned to the hospital with complaints of shortness of breath and was discovered to have a dilated cardiomyopathy with an ejection fraction of only 15%, presumed to be post-partum in etiology. She was treated medically for congestive heart failure but returned to the hospital on multiple occasions for pneumonia and sepsis. Her most recent hospitalization was for complaints of dyspnea. She was felt to have pneumonia and was intubated for respiratory distress. Upon arrival in the medical intensive care unit she suffered repeated cardiac arrests with pulseless electrical activity before her family asked that further resuscitative efforts be suspended and she subsequently expired.
