Table of Contents
Washington University Experience | VASCULAR | Infarct - Spinal Cord | 6A0 Case 6 History
Case 6 History ---- The patient was a 63 yo man s/p cardiac transplantation in 1993 for viral myocarditis with a past medical history of diabetes mellitus, pulmonary hypertension, peripheral vascular disease, CMV hepatitis (post transplant) who presented to one BJC hospital on 3/20 with a five hour history of abdominal and low back pain and several weeks of diarrhea. He was also noted to be in acute renal failure (Cr = 3.8, K+ = 8.0). On initial exam he was hypotensive, bradycardic and unresponsive. A subsequent mesenteric angiogram was negative. Beginning on 3/19 the patient noted progressive difficulty moving his lower extremities with bilateral tingling of the feet. He was noted to have dense lower extremity weakness, areflexia, and a possible T6 sensory level. An MRI of his spine revealed increased signal between T11 and L1. NCV showed small peroneal CMAPS and sural SNAPS consistent with a peripheral neuropathy. He was started empirically on valacyclovir for multiple oral ulcers. On 3/29, the patient became acutely short of breath. CXR revealed a right pleural effusion and LE Doppler exam were positive for DVT. On 4/1, the patient was found in PEA and pronounced dead after unsuccessful resuscitation attempts.
