Catastrophic chest pain: blinded by cardiopulmonary disease.

Catastrophic chest pain: blinded by cardiopulmonary disease.

Barreiro Timothy John; Asiimwe Denis D; Gemmel David; Brine Patrick

BMJ case reports

2015

2015-07

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.

*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

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2015