Make the Diagnosis: A Middle-Aged Woman with Sudden Leg Weakness

(MedPage Today) -- Case Study: A fifty-six-year-old woman presented to the emergency department with a sudden onset of dyspnea, stupor, and weakness of both lower extremities. She had been in good health until two weeks previously, during which she had undergone nonoperative treatment for lower back pain. She received ceftriaxone for a fever that developed two days before arrival in the emergency room. She had diabetes mellitus and high blood pressure, but no specific event or invasive procedure triggered the onset of the symptoms. The patients temperature was 36.5°C, and she had back tenderness and marked global weakness in both lower extremities. The laboratory findings included a white blood-cell count of 15,950 cells/mm3, an erythrocyte sedimentation rate (ESR) of 78 mm/hr, and a C-reactive protein (CRP) level of 303 mg/dL. Radiographs of the lumbar spine revealed mild degenerative changes, and chest radiographs revealed multiple round densities. A contrast-enhanced CT scan of the chest demonstrated multiple pulmonary consolidations (shown here, panel A). An abdominal CT scan revealed multiple thrombi in the inferior vena cava, the common iliac vein, and the renal vein adjacent to a mass (panels B, C, and D). MRI revealed extensive psoas, retroperitoneal, and prevertebral involvement.
Source: MedPage Today Endocrinology - Category: Endocrinology Source Type: news