A 33-year-old man with a rash, pulmonary infection, and neurologic disorder

Article Abstract:

A 33-year-old man whose legs became temporarily paralyzed was diagnosed with myelitis, which is an inflammation of the spinal cord. He also had a lung infection caused by Mycobacterium kansasii, which is related to the bacterium that caused tuberculosis.

Inflammation, Mycobacterial infections, Mycobacterium infections, Spinal cord

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A 45-year-old woman with Hodgkin's disease and a neurologic disorder

Article Abstract:

A 45-year-old woman suddenly began to experience burning sensations over her legs and trunk. Subsequently, the sensations spread to her face, mouth, teeth, and tongue. These abnormal sensations, or dysesthesias, spared her fingertips and toes. Six weeks earlier she had developed a cough, and an X-ray revealed a mass in the mediastinal cavity, between the lungs. CT scan confirmed its presence. After admission to the hospital her neurological signs deteriorated; she complained of whole-body pain, and deep reflexes were absent. The patient could not stand. There was no fever. On the morning of her fourth day in the hospital she was found without pulse and respiration, but was successfully revived. The afternoon of the following day she died. Four weeks after the development of the cough, the patient's illness was diagnosed as Hodgkin's lymphoma. Post-mortem examination revealed an acute sensory ganglionitis, or inflammation of the peripheral nerve cells, which gave rise to the abnormal sensations. The relationship of this paraneoplastic ganglionitis to the lymphoma is not clear, but it is suspected that Hodgkin's lymphoma, as well as many other neoplasms, may be a result of viral infection. The virus, as yet unidentified, may give rise to the ganglionitis as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Abnormalities, Diagnosis, Hodgkin's disease, Brain stem, Richardson, Edward P., Jr., Bronchopneumonia, Jones, H Royden

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A 21-year-old man with progressive gastrointestinal stasis, hepatomegaly, and a neurologic disorder

Article Abstract:

A 21-year-old man entered the hospital with nausea, vomiting, diarrhea, weakness, and nerve disorders. He had had diarrhea for seven years and had been treated intermittently with sulfasalazine. Abnormalities of the lymph nodes had been found by biopsy and he had signs of inflammation of the intestine. Tingling in the feet and legs had begun nine months previously; he lost weight and became weak. Swelling and inflammation of the small intestine were seen, as well as small hemorrhages in the large bowel. His sensory responses were impaired. After admission to the hospital, blood cultures showed bacteria in the blood, which antibiotics helped. The liver was enlarged and appeared fatty upon magnetic resonance imaging. Pneumonia developed, then improved, but nausea, vomiting, and diarrhea persisted. The patient's muscles showed signs of having reductions in their nerve supply . Diabetes developed and the liver became more enlarged. On the 80th day in the hospital, the patient vomited blood and suffered respiratory distress. Emergency measures failed and he died. The clinical diagnosis was chronic intestinal pseudo-obstruction (a functional obstruction), with questionable primary visceral neuropathy or visceral myopathy (disease of the nerves or muscles within the intestinal wall). An alternative diagnosis included sprue (a condition of poor nutrient absorption in the small intestine), fatty liver, septicemia (an infection that is widespread and has entered the blood), or peripheral sensorimotor neuropathy and Wernicke's encephalopathy (a brain disease) as a result of poor absorption of vitamin B. The pathological diagnosis, based on biopsies of the liver and intestine, was familial visceral myopathy, a rare condition where the smooth muscle in the intestine degenerates and is replaced by fibrous tissue. The patient also had trace-metal deficiencies of selenium and chromium, which can lead to anemia, heart damage, and diabetes mellitus. (Consumer Summary produced by Reliance Medical Information, Inc.)

Muscle diseases, Muscular diseases, Gastrointestinal diseases

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