brought to the emergency department for a difficulty exchanging the foley. In addition, the foley bag and tubing contained purple urine. According to the caretaker, the purple urine appeared 8-9 days prior to admission and had never occurred before. Aside from the foley issues, the patient denied any other symptoms. The physical exam was non- contributory aside from the foley and purple urine bag. Multiple attempts were made to remove the foley, but the patient was taken to the operating room for surgical removal. Intra-operatively, urology found calcifications around the foley balloon, which was preventing deflation. The calcifications were broken up, the foley was removed, and a suprapubic catheter was placed. Following removal and replacement, the urine draining into the bag was light yellow for the remainder of the hospital stay. Notably, the patient has a significant history of complicated urinary tract infections (including
multi drug resistant organisms) since initiating the foley in 2023. The patient was empirically started on intravenous meropenem and oral fluconazole until 3 days post-operatively (5 days total). The urine cultures post-operatively were negative, and blood cultures were positive in one bottle (likely contaminant, as repeat cultures were negative). The patient was discharged with urology follow up. Discussion: This case illustrates the importance of swift diagnosis. If the condition is left untreated, the underlying etiology of a urinary tract infection can lead to a poor prognosis, especially in those patients with chronic indwelling foley catheters. Due to its rarity, it’s likely to leave healthcare workers and family members alike surprised and alarmed at the unique finding, but prompt treatment leads to favorable outcomes.
RAPIDLY PROGRESSIVE CASE OF NEUROMYELITIS OPTICA SPECTRUM DISORDER Vy Luong, Suzanne Cooper, Conner Hartupee, Tina Benoit-Clark; Louisiana State University, Lafayette, LA.
Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune demyelinating disease primarily affecting the optic nerves and spinal cord. It is characterized by acute attacks of optic neuritis, transverse myelitis, and area postrema syndrome. The pathophysiology involves AQP4-IgG antibodies targeting the astrocytic water channels, leading to neuronal damage. Diagnosis is based on clinical symptoms, neuroimaging, serological testing, and cerebrospinal fluid analysis. Treatment involves long-term immunosuppressive therapy and high-dose corticosteroids during acute flares. Case: A 38-year-old female with a history of legal blindness presented with rapidly progressive symptoms of headache, right eye pain, and worsening vision loss in her right eye. On initial examination, she had bilateral visual impairment, pallor in the bilateral discs, and evidence of an inflammatory process in the right optic nerve on MRI. She was diagnosed with acute optic neuritis secondary to NMOSD flare. The prompt initiation of high-dose corticosteroids and plasmapheresis resulted in stabilization of the optic nerve
inflammation and prevention of further visual loss. The patient had a history of optic neuritis dating back to 2015, which led to an initial diagnosis of multiple sclerosis. Despite treatment with various medications, including Interferon beta-1b and Dimethyl fumarate, she continued to experience recurrent optic neuritis episodes, ultimately leading to legal blindness. Currently, she has been on Orelizumab with symptomatic relief for the past 3 years before the current flare, although this medication is traditionally used for multiple sclerosis and she previously was refractory to other NMOSD treatments, including Rituximab, Eculizumab, and Methotrexate. Discussion: NMOSD is a rare but devastating disorder that requires prompt recognition and management to prevent long-term disability. This case emphasizes the importance of considering the possibility of mixed diagnoses and the need for comprehensive evaluation and individualized treatment plans in complex neurological conditions like NMOSD. Further research is needed to understand the pathophysiology better and improve outcomes in this rare but challenging disorder.
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