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2015 ; 2015
(ä): ä Nephropedia Template TP
gab.com Text
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English Wikipedia
Catastrophic chest pain: blinded by cardiopulmonary disease
#MMPMID26135489
Barreiro TJ
; Asiimwe DD
; Gemmel D
; Brine P
BMJ Case Rep
2015[Jul]; 2015
(ä): ä PMID26135489
show ga
A 53-year-old man with a history of diabetic foot ulcer, osteomyelitis, coronary
artery disease, hypertension and hyperlipidaemia, presented with chest pain of
3?weeks duration. Eleven days earlier, the patient had had a drug-eluting stent
(DES) placed in a branch of the right coronary artery (RCA) after similar chest
pain, leading to the findings of a positive nuclear stress test. Since discharge,
he was not compliant with taking clopidegrel (Plavix), a concern for in-stent
thrombosis with recurrent myocardial ischaemia; but work up was negative and
medications were restarted. Within 24?h of admission, he developed bilateral
flaccid leg weakness, urine retention and loss of sensation from the umbilicus
level down. MRI revealed a T4-T6 epidural abscess. Emergent decompression
laminectomy and abscess drainage was completed. Neurological symptoms improved
hours after surgery with complete resolution of sensory deficits. Cultures grew
Streptococcus sp., treated with intravenous nafcillin for 8?weeks. He regained
leg strength with continued improvement seen in rehabilitation.