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Washington University Experience | NEOPLASMS (METASTASES) | Meningeal | 5A0 Case 5 History
Case 5 History ---- The patient was a 35 year old female with widely disseminated adenocarcinoma of the breast. She was last admitted to the hospital on 8/1979 for treatment of metastatic disease to her posterior fossa. She died on the 19th hospital day of gram negative sepsis. The patient underwent right radical mastectomy in October 1974 at the age of 31 for adenocarcinoma of the breast. Estrogen receptors were negative but the liver scan was equivocally positive. She was begun on chemotherapy. In July of 1978 she developed a right anterior chest wall recurrence that was treated with 4000 rads of radiation. She developed radiation pneumonitis following the right chest wall irradiation. Left upper lobe pulmonary metastasis were noted and persisted despite continuing chemotherapy. She received extensive chemotherapy during her most recent hospitalization that was complicated by right upper lobe pneumonia, Klebsiella sepsis, Candida esophagitis and severe generalized pain felt to be secondary to Vinblastine neuropathy. ---- Her last admission was prompted by this development of slurred speech ataxia, nausea, vomiting and severe left breast pain requiring large amounts of medications and resulting in profound constipation. A CT scan showed a midline posterior fossa mass interpreted as metastatic disease. She was begun on Decadron in anticipation of brain edema from her up-coming CNS irradiation treatments. She progressively became more lethargic and on the 19th hospital day developed non-ketotic hyperglycemia felt at that time to be due to steroids. However later that day she became febrile, comatose and hypotensive. Antibiotics were with-held in view of her terminal state. She suffered a cardiopulmonary arrest later that day and died. Blood cultures obtained earlier in the day subsequently grew Serratia marcescens.
