Ariel Antezana

Glatiramer acetate–induced acute hepatotoxicity in an adolescent with MS

Similar to Makhani et al.,1 we saw a case of glatiramer acetate (GA)–induced hepatotoxicity with no history of interferon exposure. A 28-year-old woman with multiple sclerosis developed jaundice, choluria, acholia, elevated aspartate aminotransferase/alanine aminotransferase (905/1,103 U/L) and direct and total bilirubin …

Group B streptococcus endocarditis associated with multiple pulmonary septic emboli

Endocarditis is a rare presentation of group B streptococcal infection. Its association with pulmonary septic embolism was only barely studied and limited data is available up to date. Multiple septic emboli is a common complication of bacterial endocarditis, but only a few cases have been documented in relation to group B streptococcus. We present the case of an 87 year old female patient with multiple underlying conditions that predisposed the development of bacterial endocarditis secondary to group B streptococcus and subsequently multiple pulmonary septic emboli. The patient was treated with ceftriaxone and azythromycin with good response and complete recovery without any further complications. In the event of a diagnosed case of group B streptococcus endocarditis, there should be a low threshold for the suspicion of septic pulmonary emboli especially in cases with right valves involvement.

Susumber berries: Unexpected cause of cholinergic poisoning

A 65-year-old Jamaican man with no significant medical conditions was brought to the emergency room (ER) after he had suddenly developed abdominal pain, profuse vomiting, and subsequent blurred vision, dysarthria, bilateral hand weakness, and unsteady gait. His initial vital signs and general physical examination were normal. His neurologic examination was significant for widely coarse opsoclonus; severe labial, lingual, and palatal dysarthria; distal weakness of his bilateral wrist extensors (4/5), interossei (4−/5), and opposition (4−/5); dysmetria; presence of Woltman sign, or delayed deep tendon reflexes; and severe gait ataxia. Upon speaking to his wife, who was also in the ER for abdominal pain, we discovered that she too had opsoclonus, dysarthria, bilateral hand weakness, dysmetria, and the presence of Woltman sign, though all to a lesser degree. She revealed that the prior evening, they had eaten an “authentic Jamaican dinner,” consisting of codfish, ackee, and frozen, uncooked susumber berries, which she had imported from Jamaica 3 weeks earlier and later frozen. He had consumed more of the susumber berries than she. As he was more severely affected, immediate MRI of the brain to assess for any acute brainstem pathology was performed, but it was normal. After measurement of vital capacities, his being 0.9 L and hers being 1.2 L, both were admitted to the medical intensive care unit for supportive care. The following day, despite being bradycardic to the 40s, her general and neurologic examinations were completely normal. Her husband had minimal L wrist extension weakness (4+/5), with resolution of the other signs and symptoms. Their creatine kinases and transaminases had risen dramatically but responded to aggressive medical management. As they recovered well, an EMG/NCS was not performed. They were discharged home on day 3 of the hospitalization.

Inclusion Body Myositis: A Case Presenting with Respiratory Failure and Autopsy Findings Leading to the Hypothesis of a Paraneoplastic Cause

Patient: Female, 48 Final Diagnosis: Inclusion body myositis Symptoms: Shortness of breath • weakness Medication: — Clinical Procedure: Biopsy Specialty: Neurology Objective: Rare disease Background: Sporadic inclusion body myositis (IBM) is the most common acquired myopathy seen in adults aged over 50 years, with a prevalence estimated at between 1 and 70 per million. Weakness of the diaphragm with loss of vital capacity is almost universal in IBM. This is almost always asymptomatic. When respiratory complications occur, they are most often due to aspiration. Respiratory failure due to diaphragmatic weakness is exceptionally rare, particularly as the presenting symptom of the disease. It is not currently considered to be a paraneoplastic syndrome. Case Report: Our patient presented with hypercarbic respiratory failure. This is the first such reported case without signs of weakness elsewhere of which we are aware. We suspected IBM based on her history of progressive weakness and findings on electromyography. There was a delay of 5 years in obtaining biopsy for confirmation, during which she presented with recurrent episodes of respiratory failure despite using non-invasive ventilation. An autopsy revealed the presence of papillary thyroid carcinoma with spread to local lymph nodes. On the basis that these co-morbidities are unlikely to have occurred by chance (we estimate 1×10−17), we hypothesize that IBM may be a paraneoplastic condition. We acknowledge that proof would require demonstrating a pathogenic antibody. Conclusions: IBM should be considered in older patients (age >45) presenting with otherwise unexplained respiratory failure. A workup for possible malignancy in this setting appears reasonable.

A Case of Encephalopathy in an Immunocompetent Adult with Persistent Parvovirus B19 Viremia

Parvovirus B19 (PVB19) is a ubiquitous airborne virus; it is well known to cause erythema infectiosum (fifth disease) in children. Neurologic complications after PVB19 exposure are thought to be transitory and infrequent in the adult population. Herein, we report an interesting case of a young woman who developed cognitive deficits, white matter changes and persisting viremia for over a year after exposure to PVB19.

Diversity of Neuromyelitis Optica: Inner City Hospital Experience andReview of Literature

Neuromyelitis Optica (NMO) is a potentially devastating, complex autoimmune disease of the central nervous system that differs clinically and pathologically from the more common Multiple Sclerosis (MS). In this paper, we briefly describe our clinical experience with NMO patients treated in an inner city hospital in central Brooklyn, New York, and offer a an up-to-date discussion of diagnosis, treatment, and prognosis of this rare condition.