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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Central Pontine Myelinolysis (CPM) | 10A0 Case 10 History
Case 10 History ---- The patient was a 51 year old man with a history of chronic seizure disorder since 7.5 years of age, which was initially generalized tonic-clonic type. The seizure disorder was treated with Dilantin, Mysoline, Tegretol, Felbatol, and Depakote. The seizure frequency was approximately twice per month. EEG in 2/95 showed the presence of a right anterior temporal focus which was thought to be a specific interictal epileptiform abnormality. A head MIR showed no temporal lobe abnormality. The patient was also started on Lamictal in 2/95 for treatment of seizure disorder. In 12/95, the patient developed leukocytopenia, severe thrombocytopenia and splenomegaly. Bone marrow biopsies (x2) were performed in 1/96, which showed highly atypical lymphoid aggregates, suggestive of but not diagnostic of Non-Hodgkin's lymphoma but were not confirmed by splenectomy. Several weeks before his last admission, the patient developed insomnia, dizziness, weakness, lethargy, unexplained weight loss (20 lbs) mild ataxia, and fever. The patient developed hypotension and was subsequently transferred to MICU service. Peripheral blood cultures were positive for coagulase-negative Staphylococcus species; however, repeated cultures from urine, CSF, and bronchioalveolar lavage were negative. An MRI of the head on 5/29/96 showed diffuse patchy meningeal enhancement and thickening. Flow cytometry of peripheral blood (6/6/96) showed involvement by a Non-Hodgkin's lymphoma of T-cell type (peripheral T-cell lymphoma), and a bone marrow biopsy also revealed involvement. On 6/10/96 at 07:20, the patient suddenly developed bradycardia, hypotension, and high airway pressure. He was unable to be resuscitated and was pronounced dead.
