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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, immune-compromised | 4A0 Case 4 History
Case 4 History ---- The patient was a 36-year-old man with a history of AIDS. HIV was diagnosed in 1994 and his most recent CD4 count was 2. His course was complicated by a number of opportunistic infections such as PCP pneumonia and toxoplasmosis. He was admitted in March 2001 to the neurology service for workup of 3-4 month history of progressive sensory symptoms (tingling and numbness) and weakness in all extremities, with the legs more involved than arms. In February 2000, weakness became severe enough that he started needing assistance with most activities of daily living. In addition to the weakness and sensory symptoms, his wife noticed progressive difficulty with short term memory. On exam on the day of admission and several hours before death, he had a normal mental status with slightly impaired short term memory, normal cranial nerves, and abnormal sensory and motor exams. On his sensory exam, he had decreased pin prick in a “stocking and glove” distribution and severely decreased proprioception and vibratory sensation (L>R). Motor exam, he had symmetric distal lower extremity weakness, especially in the lower extremities; his ankle jerks were absent and toes were both upgoing. A sensorimotor neuropathy as well as a central, bilateral process was considered and the patient was sent for a MRI of the head. This procedure was to be followed by a lumbar puncture for investigation of infectious etiologies in the setting of AIDS; however, the patient developed chest pain, shortness of breath and diaphoresis. Upon return to the floor, he was given a treatment of albuterol; shortly after that, he became unresponsive and was noted to have R gaze deviation. The patient was subsequently intubated for respiratory protection and transferred to the ICU where he went into V-tach alternating with pulseless electrical activity. The patient was coded in the standard fashion without success for about 15 minutes and was pronounced dead. There was no clear etiology of the terminal events.
