Age: 24.0
Sex: F
Vaccine: HPV4
Symptoms: Lumbar puncture normal, Lupus nephritis, Muscular weakness, Nerve conduction studies abnormal, Nuclear magnetic resonance imaging normal
Clinical narrative: SLE diagnosed 10/2010 months ago admitted with progressive weakness, numbness, and tingling in her lower extremities for last 2 weeks prior to admission. 1.  Acute infective demyelinating polyneuropathy, likely Guillain-Barre syndrome.  Patient gave a history of progressive weakness, numbness, and tingling following a bout of gastroenteritis.  She stated that her symptoms had gotten progressively worse for 2 weeks and was having difficulty with walking. Extensive workup including MRI, CT scan, as well as lumbar puncture.  A lumbar puncture did not show any evidence of infection.  MRI showed no evidence of infarction.  CT brain was negative.  MRI of the spine showed abnormal thickening and enhancement of the ventral and dorsal cauda equina nerve roots, likely compatible with Guillain-Barre syndrome.   Patient was started on 5 doses IVIG therapy with the last dose on 4/22/2011.   EMG and nerve conduction studies on 4/15, and the EP findings were consistent with acute severe infective demyelinating polyneuropathy consistent with possible Guillain-Barre syndrome.  Patient never had any plasmapheresis done.  Started on Solu-Medrol, which was later changed to prednisone.  Her FVC was maintained at greater than 2 L always, and it was checked every shift. Patient still continues to have some lower extremity weakness. To TIRR for therapies  2.  Acute renal failure, likely secondary to lupus nephritis.  During the hospital course, she was noted to have acute renal failure around 4/17/2011.  Her kidney function worsened, and she underwent a renal biopsy on 4/20/2011, which showed class 5 membranous acute glomerulonephritis consistent with lupus nephritis, as well as marked acute tubular injury.  Patient was started on dialysis, and she later had a Perm-A-Cath placed and continues to be on hemodialysis. 3.  Acute blood loss anemia, likely secondary to retroperitoneal hematoma from Bipsy site plus bleeding from femoral catheter site after removal plus anemia of chronic disease, given iron study showing elevated ferritin.  Following the kidney biopsy, patient was noted to have a significant drop in hemoglobin.  She was noted to have developed right renal hematoma, for which she was managed symptomatically. Also, she had iron studies, which showed elevated ferritin consistent with anemia of chronic disease, and renal is on board for the same. 4.  SLE.  Patient was diagnosed with SLE about 6 months ago, and her anti-ANA, anti-Smith/anti-RNP, as well as anti-double stranded DNA along with anti-SSA/anti-SSB antibody positive.  Rheumatology has been on board throughout the hospitalization, and her hydroxychloroquine was continued.  Solu-Medrol was later changed to prednisone as per rheumatology recommendations, and patient will continue prednisone 60 mg daily, and rheumatology will see her at TIRR and adjust dose accordingly.  Patient has not been restarted on CellCept, which was held given her worsening renal function.  Rheumatology will follow up at TIRR regarding the same. 7.  Hypertriglyceride:pt started on niacin 8.  Hypertension.  blood pressures were noted to be elevated and placed on Norvasc and appear to be better controlled now.