Table of Contents
Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Spinal Cord | 5A0 Case 5 History
Case 5 History ---- The patient was a 54-year-old woman with a 17 year history of relapsing-remitting multiple sclerosis (since 1998) and paraplegia with recurrent urinary tract infections. No specific records of her diagnosis or treatment are available prior to 2008 other than having received intermittent steroid treatment approximately 6 times during that 10-year period. MR imaging of the brain performed in 2007 also showed nonspecific periventricular white matter gliosis and no enhancing lesions. In 2008 she was wheelchair-bound and was numb in her lower extremities. She had been recently hospitalized for steroid treatment, with marked improvement in her symptoms. She was again hospitalized in June 2011 for fatigue, language difficulties, upper extremity weakness, swallowing difficulties, double vision, and an acute change in balance over the past 2-3 days. She experienced similar exacerbations possibly three times per year, each requiring hospitalization. Her last exacerbation had been in January of 2011. She had been on Betaseron for the prior three years, with approximately seven attacks. She also failed Avonex and Copaxone before that and had a possible reaction to Rebif. She had had one recent episode of left optic neuritis. MR imaging at that time showed right posterior-frontal subcortical, right occipital, and left thalamic foci of T2/FLAIR signal abnormality consistent with demyelination. Her ongoing and terminal issues included paraplegia, fatigue, pain, including burning pain in her legs, spasms, and a neurogenic bowel and bladder. She presented to the emergency department with hypoxia and a fever of 102.9 F, tachycardia and tachypnea. A chest X ray showed left basilar airspace consolidation, without an identified organism, and she worsened even though treated with multiple antibiotics. Later she was thought to be improving, was discharged but soon thereafter she was found unresponsive in her bed.
