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Text
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URL Address
<a href="http://doi.org/10.1136/bcr-2015-209928" target="_blank" rel="noreferrer noopener">http://doi.org/10.1136/bcr-2015-209928</a>
Volume
2015
Dublin Core
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Title
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Catastrophic chest pain: blinded by cardiopulmonary disease.
Publisher
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BMJ case reports
Date
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2015
2015-07
Subject
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*Decompression; *Laminectomy; *Magnetic Resonance Imaging; Administration; Anti-Bacterial Agents/*administration & dosage; Chest Pain/diagnosis/drug therapy/*etiology; Coronary Disease; Diabetic Foot; Drug-Eluting Stents/*adverse effects; Epidural Abscess/*etiology/surgery; Humans; Hypertension; Intravenous; Male; Middle Aged; Nafcillin/*administration & dosage; Osteomyelitis/*complications/diagnosis/drug therapy; Surgical; Treatment Outcome
Creator
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Barreiro Timothy John; Asiimwe Denis D; Gemmel David; Brine Patrick
Description
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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.
Identifier
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<a href="http://doi.org/10.1136/bcr-2015-209928" target="_blank" rel="noreferrer noopener">10.1136/bcr-2015-209928</a>
Rights
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
*Decompression
*Laminectomy
*Magnetic Resonance Imaging
2015
Administration
Anti-Bacterial Agents/*administration & dosage
Asiimwe Denis D
Barreiro Timothy John
BMJ case reports
Brine Patrick
Chest Pain/diagnosis/drug therapy/*etiology
Coronary Disease
Department of Internal Medicine
Diabetic Foot
Drug-Eluting Stents/*adverse effects
Epidural Abscess/*etiology/surgery
Gemmel David
Humans
Hypertension
Intravenous
Male
Middle Aged
Nafcillin/*administration & dosage
NEOMED College of Medicine
Osteomyelitis/*complications/diagnosis/drug therapy
Surgical
Treatment Outcome