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Washington University Experience | NEOPLASMS (METASTASES) | Meningeal | 7A0 Case 7 History
Case 7 History ---- The patient was a 70-year-old woman with a history of metastatic breast cancer to bone and lungs who was also clinically suspected to have carcinomatous meningitis, either from metastatic breast cancer or a primary tumor of the brain. Her breast cancer was diagnosed in May 2005, when the patient presented with hypercalcemia and lytic bone lesions. A bone marrow biopsy at that time showed metastatic breast cancer. She previously had a lumpectomy that showed ductal carcinoma in situ done in 1996 but had no other history or evidence of invasive breast cancer. The patient had received several cycles of chemotherapy for her metastatic carcinoma. Her past medical history is also significant for insulin dependent diabetes mellitus, hypertension, coronary artery disease, and past myocardial infarction in 1999 with coronary artery stent placement in 1999 and 2000, gastroesophageal reflux disease, depression, macular degeneration and arthritis. In 6/2006, the patient had a right frontal Rickham reservoir placed for intrathecal chemotherapy for the carcinomatous meningitis and received 4 doses of chemotherapy via the reservoir. In 7/2006, the patient presented to the ER with a 24 hour history of lethargy, weakness and confusion after falling at home and hitting her head in the right frontal area. Head CT did not show brain contusion or hemorrhage. The fluid in her Rickham reservoir was tapped and the CSF was positive for gram positive cocci and an elevated white blood cell count. The day after admission the presumably infected CSF reservoir was removed, a right frontal ventriculostomy was performed and a catheter was placed for intrathecal antibiotic administration. Her CSF culture and cultures of the Rickham catheter both grew Staphylococcus aureus but her blood cultures and urine cultures were negative. At this point the patient was diagnosed with Staph aureus bacterial meningitis superimposed on the carcinomatous meningitis and treated with multiple intrathecal antibiotics including Vancomycin, Gentamycin and Rifampin. The patient recovered clinically from the meningitis but she made the decision to decline any further treatment including chemotherapy and antibiotic treatment and expired shortly thereafter.
