Page 24 - Delaware Medical Journal - February 2016
P. 24
Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.”
Second Place – Poster Competition
Susan Joan Chinnery, Second Lieutenant, United States Air Force, DesMoines University; and Sharath Kharidi, MD, Christiana Care Health System, Newark, Del.
Introduction: This case discusses Wernicke encephalopathy in a non-alcoholic patient and describes the extensive work-up the patient experienced. She was a repeat admission after being discharged
the previous day and returned with sudden onset vertigo, ataxia,
and diplopia.
Case Description: The patient was a 30-year-old right handed
colitis (UC) and elevated transaminases of unknown etiology.
Her previous admission was complicated by a seizure in the emergency department and acute delirium with visual and auditory her seizure and subsequent delirium was unremarkable.
At this admission, the patient reported a headache and denied fevers, chills, diarrhea, constipation, shortness of breath or pain. She also reported a 10 pound weight loss over the last few months. She states she only drank on rare occasion, stopped smoking six months ago, and denied using any other illicit drugs, over-the-counter medications, or herbal supplements.
A CT head without contrast ordered showed “possible small subdural hematomas over both temporal convexities although they could be mass effect.” An MRI and MRA head and neck revealed “no acute intracranial process or parenchymal mass.” Urine drug screen
this admission was negative. The patient was seen by Neurology
who performed a lumbar puncture (unremarkable) and ordered Cryptococcal Antigen (negative) as well as Vitamin E and B1 (Thiamin) levels. Her previous admission RPR was non-reactive and her folate and B12 levels were normal. HIV1 and HIV2 were negative.
Neurology suspected Wernicke encephalopathy and she was treated with thiamin IV. After rapid improvement over the next
– Sir William Osler
two days, she was discharged home on oral thiamine supplements and encouraged to follow up with her gastroenterologist. There was concern for possible autoimmune disease and malabsorption secondary to her UC. A thiamine level ordered prior to supplementation resulted at 47 (normal 70-180).
Discussion: This case demonstrates Wernicke encephalopathy
in a non-alcoholic patient. She was subject to radioactive imaging, multiple colonoscopies, upper GI studies, ultrasounds, CT Head, MRI Head, MRA head and neck, a liver biopsy, and lumbar puncture over the past year. In addition, she faced repeated questioning as to her drinking status by physicians who felt she was clearly alcoholic, given her elevated liver enzymes and acute delirium. This patient later admitted to a diet consisting only of granola bars and Gatorade, which was the likely cause of her weight loss. Her BMI this admission was 17. This case heightens the awareness of Wernicke encephalopathy presenting in a non-alcoholic patient.
Third Place - Poster Competition
Rino Sato, MS-IV, Sidney Kimmel Medical College, Thomas Jefferson University; and Ramya Varadarajan, MD, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Del.
Introduction: Without treatment Acute Promyelocytic Leukemia (APL) is the most malignant form of Acute Myeloid Leukemia (AML) with a median survival of less than one month.1,2 In this case, an 85-year-old white female developed APL and received a relatively new chemotherapy-free regimen with minimal side effects and consideration in the treatment of APL.
Case description: An 85-year-old white female with no severe fatigue and abdominal discomfort and was found to be pancytopenic with WBC 900, Hgb 9.4, Plts 85. A subsequent bone marrow biopsy revealed acute promyelocytic leukemia with 80 35 percent blasts with CD45, CD13, CD33, and CD117 positivity with CD34 and HLA-DR negativity. The patient began a regimen of
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Del Med J | February 2016 | Vol. 88 | No. 2
