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The patient is a 22 year old Hispanic male with little past medical
history. He developed a cough in late February. It progressed to vomiting
which
resulted in admission on 3-18-03 for rehydration and an initial diagnosis
of gastroenteritis was made. His symptoms worsened. A chest/abdomen
CT
scan was performed revealing a right upper lobe cavitary lesion suggestive
of septic emboli to the lung. An echo revealed mitral valve vegetations
and the patient was started on antibiotics.
The patient was neurologically intact on 3-18-03 but by 3-20-03 was
complaining of photophobia and had dimming of his vision with blurring.
By the next
day he was entirely blind and he lost speech. On 3-25-03 he lost the
use of his entire right side and on 4-3-03 he lost the use of his left
side
and his ability to swallow. Because of the extent of his disease he was
transferred to this hospital on 4-4-03.
Name |
Result/Unit |
|
Ref Interval |
PTT 1:1 MIX |
28 sec |
|
26-37 |
PROTHROMBIN TIME |
18.8 sec |
H |
12.0-15.5 |
INTERNATIONAL NORMALIZED RATIO |
1.6 ratio |
|
|
PARTIAL THROMBOPLASTIN TIME |
41 sec |
H |
26-37 |
FIBRINOGEN |
118 mg/dL |
L |
150-430 |
D-DIMER |
36.6 ug/mL |
H |
0.0-0.5 |
CBC |
Result/Unit |
|
Ref Interval |
WHITE BLOOD CELL COUNT |
27.47 K/uL |
H |
3.20-10.60 |
RED BLOOD CELL COUNT |
3.67 M/uL |
L |
4.69-6.07 |
HEMOGLOBIN |
11.5 g/dL |
L |
14.6-17.8 |
HEMATOCRIT |
32.1 % |
L |
40.8-51.9 |
MEAN CORPUSCULAR VOLUME |
87.5 fL |
|
77.8-94.0 |
MEAN CORPUSCULAR HEMOGLOBIN |
31.2 pg |
|
26.5-32.6 |
MEAN CORPUSCULAR HGB CONC |
35.7 g/dL |
|
32.7-36.9 |
RED CELL DISTRIBUTION WIDTH |
14.5 % |
H |
10.8-14.1 |
PLATELETS |
69 K/uL |
L |
177-406 |
MEAN PLATELET VOLUME |
8.2 fL |
|
5.9-9.8 |
BMP |
Result/Unit |
|
Ref Interval |
SODIUM |
126 mmol/L |
L |
136-144 |
POTASSIUM |
4.5 mmol/L |
|
3.3-5.0 |
CHLORIDE |
96 mmol/L |
L |
98-107 |
CARBON DIOXIDE |
24 mmol/L |
|
22-29 |
UREA NITROGEN |
33 mg/dL |
H |
9-22 |
CREATININE, SERUM - mg/dL |
1.1 mg/dL |
|
0.8-1.5 |
GLUCOSE |
93 mg/dL |
|
64-128 |
ANION GAP |
6 mmol/L |
L |
8-14 |
CALCIUM, SERUM OR PLASMA |
8.5 mg/dL |
|
8.4-10.2 |
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Chest X-Ray from 4-4-03 |
1. What is your differential diagnosis?
2. Review the Chest film from 4-4-03 on admission. Are there any abnormalities?
3. Review the labs from 4-4-03. Are there any clues to his illness?
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