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Washington University Experience | PERIPHERAL NEUROPATHY | 9A SARCOID | 4A0 Case 4 History
Case 4 History ---- The patient was a 39 year old African-American man with a history of seizures and hydrocephalus who was status-post multiple ventriculoperitoneal and ventriculoatrial shunt placements. Additional medical history included sarcoidosis, pulmonary embolism, gastrointestinal bleeding, and pseudomonas urinary tract infection. During a past incarceration, the patient suffered from progressive mental decline of unknown etiology. From June through December 1995, the patient suffered episodes of ileus with abdominal distension and urinary system infection requiring multiple hospitalizations. The differential diagnoses for the cause of the hydrocephalus included neurosarcoidosis, bacterial meningitis, or meningeal tuberculosis. Along the course of his illness, he was treated empirically with steroids for presumed neurosarcoidosis; anti-tuberculosis medicine for possible meningeal tuberculosis; and a variety of antibiotics. In 12/95, he was hospitalized for a pulmonary embolism. He was treated with anticoagulation. During that hospitalization, he developed an ileus and a gastrostomy tube was placed. The patient's condition was stabilized and he was discharged in 1/96 with a scheduled return visit for meningeal biopsy. On the next day, the patient returned to BH for low blood pressure and altered levels of consciousness. A head CT revealed no evidence of hemorrhage. An obstructive series and chest x-ray were unrevealing. The patient's further work-up included an open brain biopsy on 1/17, that showed meningeal fibrosis of unknown etiology. His mental status continued to deteriorate and he suffered from multiple seizures. The next day, the patient suffered two seizures and was later found unresponsive and pulseless with no blood pressure or respirations.
