Case 37-2010 — A 16-Year-Old Girl with Confusion, Anemia, and Thrombocytopenia  

Oleh:

Binder, W.D. ; Traum, Avram Z. ; Makar, R.S. ; Colvin, Robert B.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 363 no. 24 (Dec. 2010), page 2352-2361.
Topik: Anemia; Thrombocytopenia

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2010.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Presentation of Case Dr. Michele S. Duke (Pediatrics): A 16-year-old girl was seen in the emergency department of this hospital because of confusion, anemia, and thrombocytopenia. The patient had lupus nephritis but had been well until approximately 7 days before admission, when malaise developed, associated with frontal headaches, light-headedness when rising, fatigue, palpitations, and shortness of breath. Episodes of nausea and vomiting occurred that prompted her to leave school early. Two days before admission, she saw her primary care physician; the examination was reportedly normal, and no laboratory tests were performed. The symptoms were attributed to a recent tapering of prednisone and stress associated with school. At approximately 9:30 p.m. on the night of admission, right-sided weakness and numbness involving the face, limbs, and abdomen suddenly developed. The patient's parents took her to the emergency room at another hospital, arriving at 11 p.m. On examination, the patient was awake and appeared in distress, moaning. She reported abdominal pain. The temperature was 38.4°C, the blood pressure 109/56 mm Hg, the pulse 98 beats per minute, the respiratory rate 18 breaths per minute, and the oxygen saturation 100% while she was breathing ambient air. The oral mucous membranes were dry. Strength in the right arm was reportedly decreased, and the gait was unsteady; the examination was otherwise normal. Serum levels of creatine kinase, creatine kinase isoenzymes, and troponin I were normal; other results are shown in Table 1Table 1 Laboratory Data.. Urinalysis showed 1+ protein. An electrocardiogram was normal. Computed tomography (CT) of the head without the administration of contrast material was normal. Hydromorphone, metoclopramide, ondansetron, and normal saline were administered intravenously. During the next 2 hours, the patient reported that numbness extended to involve the left side, and increasing confusion and agitation developed. Approximately 2.5 hours after arrival, she was transferred to the emergency department at this hospital, arriving 40 minutes later.

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