Age: 14.0
Sex: M
Vaccine: TD
Symptoms: Syncope, Tachypnoea, Unresponsive to stimuli, Urine analysis abnormal, Vomiting
Clinical narrative: Pt received update with DipTes after getting chemical burns to eyes. 1 week later he presented with extreme weakness. He was transferred to hospital where he was hospitalized and then required rehabilitation. He still is having problems. Was given a diagnosis of transverse myelitis as leading DX. Annual followup 01/4/2010 I don't know that it is related at all. He developed transverse myelitis and still suffers from it. 11/01/2006 Lengthy hospital MR received which documents 11 distinct ER admissions and several admissions and/or transfers to pediatric ICUs beginning on 8/15/2005 when he received a TD booster.  PMH: Asthma, recurrent UTI's, partial ileal resection for necrotic bowel as an infant, ear tubes x 2, umbilical hernia repair. He initially presented approximately 1 week after his Td, with c/o motor sensory neuropathies bilaterally in the legs, with rapidly progressing lower extremity numbness and weakness. He was given a diagnosis of encephalomyelitis/ transverse myelitis and transferred to a PICU, where he apparently was treated with steroids and placed in rehab./pc The first ER visit of 12/05/2005 was for increased weakness. LABS: WNL, drug screen negative. There is reference to another ER visit of Jan. 24th where he presented in an obtunded state and with nausea and vomiting. LABS and DIAGNOSTICS: WNL except for hypokalemia, EKG non-specific ST and T wave changes, prominent E waves, prolonged QT. CT of head WNL.   He was intubated and transferred to a PICU, where he apparently awakened 14 hours later and was fine. Transfer DIAGNOSIS: Obtundation-etiology unclear, ? recurrence or exacerbation. Nausea, Vomiting and abdominal pain. He returned to the ER on Feb. 05, 2006 via ambulance unconscious.  LABS: WNL except for a K of 3.2.  Tox screen negative.  EKG: sinus tachycardia. Upon transfer to the ICU he awakened, but was unable to speak. Admitted for observation and discharged on Feb. 07, 06. Assessment: ? Atypical seizures or possible chronic encephalomyelitis. Final Discharge DX: Obtundation-etiology unclear, Hx of encephalomyelitis and transverse myelitis. Next ER visit on March 02,2006 was for c/o chest pain which dissipated in the ER.  LABS and DIAGNOSTICS: EKG- Normal Sinus rhythm with slight ST elevation in lead V2, but not seen in V1 or V3.  Labs significant for elevated Liver Enzymes.  Discharged home to F/U as needed. Next ER visit was March 27,2006  was for vague chest pain followed by loss of consciousness.  Awakened in ER where his exam was normal. LABS: unremarkable except elevated Alk. Phos., tox screen negative, Strep A screen negative.  To continue with scheduled sleep study. Assessment:  Syncopal episode vs. seizure. Next ER visit on April 11,2006 for an exacerbation of asthma. Tx's with albuterol MDI, Flovent and azithromycin. Presented in the ER again on April with c/o facial tenderness and fever. Assessment:  Sinusitis txd with Augmentin. ER visit of 09/10/06 after being found in the bathroom unresponsive.  He had reported feeling sick to his stomach, having some chest pain, and feeling like he was going to faint.  There was evidence that he had vomited. LABS: normal  CT of the head: normal. He awakened in the ER and had a normal exam with the exception of some resistance to having his eyes opened, and eyes deviating to the left. Assessment:  Acute episode of unresponsiveness of unclear etiology, but recurrent.  Discharged home in stable condition. ER visit of 09/12/2006 for c/o stabbing chest pain and Right upper and lower quadrant abdominal pain.   LABS and DIAGNOSTICS: Labs remarkable for K of 3.5, Alk. Phos. of 256. UA shows 3-5 white cells.  EKG shows some non-specific ST and T wave changes. Impression:  Pleuritic chest pain 2' to pleurisy or pericarditis, etiology unclear. ER visit of 09/21/2006 for c/o SOB and increase in asthma symptoms. Assessment : Atypical chest pain, Tachypnea and possible anxiety reaction, exacerbated by use of albuterol, hx. of transverse myelitis with residual neurological problems.  Discharged home. ER visit of 09/27/2006 for sudden onset of anterior chest pain. LABS and Diagnostics:  Labs unremarkable except Alk. Phos. of 256.  CXR normal. EKG sinus rhythm-no ST changes. Assessment:  Pleuritic chest discomfort of non-apparent etiology. ? reflux issues with lower esophageal spasm. ? Costochondritis. To F/U with MD for echocardiogram which was reported normal on 10/09/2006  11/03/2006: Additional MR requested for PICU admissions and another hospital in another city./pc 11/06/2006: Faxes of 11/03 to Hosp. did not go through, resent today-completed./pc 11/13/2006: Letter from Hosp received stating that patient is being followed for a possible dx. of multiple sclerosis.  Suggested Brain MRI if not already done. Hosp. is awaiting records from treating MD in another city./pc 11/21/2006: 4 separate discharge summaries received from Medical Center.   DISCHARGE DX: for Admit 8/24/2005-8/30/2005 1) Transverse Myelitis 2) Improved mental status changes, as well as sensory and motor neuropathy  3) Neuropathic pain DISCHARGE DX: for Admit 8/30/2005-9/09/2005 to inpatient rehab 1) Encephalomyelitis of unknown etiology 2) Impaired high cognition  3) Weakness in the 4 extremities, more involving the lower extremities along with severe sensory loss. DISCHARGE DX: for Admit 10/15/2005-10/21/2005  1)  Exacerbation of Transverse Myelitis  2)  Optic neuritis, which is medically stable. Discharge note for Admit of 1/24/2006-1/27/2006 reports that most recent symptoms (obtundation) were c/w transverse myelitis./pc Per 60 day follow up: It is now felt this patient has multiple sclerosis (or similar) ? concidiental timing.