Dear Colleagues
Thanks to all for the helpful suggestions about this case posted a few
weeks ago. I don't have the final answer but the following facts have
emerged:
The case:
A 74 year old lady admitted with inanition and bed sores. History of
previous diarrhoeal illness ? GI infection. Rapidly became unresponsive
once admitted and required ventilating on ITU.
No evidence of MI on ecg.
Working diagnosis:
Guillain-Barre syndrome or Polymyositis
(Not typical of either).
Results: (Sorry if they don't tabulate on your browser)
Date CK CKMB TroponinT TroponinI (Abbott)
IU/L ug/L ug/L ug/L
<200 0 -5 <0.1 0 - 0.4
5.8 1323 583 3.58
6.8 1178 150 3.46
7.8 692 132 2.65
8.8 753 78 3.01 1.6
9.8 859 0.8
10.8 825
11.8 666
18.8 254
22.8 178 (Today)
Electrophysiology:
Predominantly neuropathic ? atypical axonal guillain barre (whatever
that means).
Muscle biopsy:
Predominantly neuropathic but some myopathic features. No evidence of
inflammatory myopathy.
Electrocardiograph:
Originally L-axis deviation, now normal.
Conclusion.
She probably had an MI originally but it may have been symptomless due
to neurological condition. She required considerable inotropic support
on ITU which she should not have needed just due to respiratory failure
from guillain barre, although she was also potentially septicaemic from
pressure sores. However, we dug out some old samples. This lady had
been treated for Paget's disease with pamidronate (hence her
hypocalcaemia). We found two bone alk. phos. stored samples from visits
prior to her pamidronate infusion.
November 99 CK 43 TropT <0.01 CKMBmass 1.2
May 00 CK 5915 TropT 2.78 CKMBmass 387
So something cardiac also happened in May although again she was
asymptomatic from a cardiac point of view.
We have tested for heterophilic antibodies without any evidence of
interference in either CKMBmass or TropT.
She clearly has had some cardiac damage, although the cause of this is
not clear.
Further comments would be welcome.
Trevor
Dr. T.A. Gray
Department of Clinical Chemistry
Northern General Hospital
Sheffield S5 7AU
0114 271 4309
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