hypertension, hyperlipidemia, and monoclonal gammopathy of undetermined significance presented with a persistent, throbbing bilateral headache that gradually intensified over a week. One week prior, she experienced “viral-like symptoms” and increased stress. Twelve hours before presentation, she awoke with a pressure sensation and unremitting tingling on the left side of her face and mouth, followed by lightheadedness and loss of balance. Upon examination, her vitals showed mild hypertension, tachycardia (137 bpm), and tachypnea (20 bpm); she was afebrile. The physical exam revealed a right-sided facial droop, sensory asymmetry, and weakness in her right lower extremity (4 out of 5). “Stroke Code” was called, and an immediate CT and CT angiogram of the head indicated no acute intracranial abnormality. Neurology assessed her with an NIH Stroke Scale score of 3, noting focal sensation abnormalities without focal weakness. The patient later developed sensitivity to light and a new headache, along with a dermatomal vesicular rash on her lumbar back,
suspicious for Herpes Zoster, leading to isolation and initiation of oral valacyclovir. A lumbar puncture confirmed Varicella Zoster Virus meningitis, with no other pathogens detected. Following recommendations, valacyclovir was discontinued, and she was transitioned to 15 mg/kg intravenous acyclovir for 14 days. Throughout her hospital course, her condition remained stable, and her neurological deficits improved. She was discharged with follow- up instructions for her primary care provider. Discussion: This case highlights the seriousness of VZV, where a patient presented with viral meningitis secondary to herpes virus reactivation, initially resembling stroke symptoms. The vesicular rash, easily overlooked on darker skin, underscores the need for thorough physical exams. Ignoring lumbar pruritus and burning without visible rash could delay treatment. Key lessons include the importance of history-taking, physical exams, and attentive listening.
UTERINE FIBROIDS WITH IVC COMPRESSION; A RARE CAUSE OF DEEP VEIN THROMBOSIS Rahul Robaish Kumar, FNU Arti, Sham Kumar, Harikrishna Bandla, Navin Ramlal; St. Francis Medical Center, Monroe, LA.
Introduction: A deep venous thrombosis (DVT) is a serious vascular condition that is typically associated with identifiable risk factors such as immobilization, surgery, or coagulation disorders. DVT’s can be classified as provoked when they occur secondary to identifiable risk factors or unprovoked when they occur without any clear triggers or underlying conditions. Case: A 46-year-old female presented with left lower extremity swelling and pain that had been going on for 4 days. Initial blood work was significant for iron deficiency anemia and elevated D- dimer levels. Work up with a left lower extremity ultrasound was significant for a DVT extending from the femoral to the popliteal vein. Initial management included therapeutic enoxaparin and mechanical thrombectomy, which she tolerated well. Notably, examination of the patient’s lower abdomen showed marked firmness and a palpable mass. Upon further questioning, it was discovered that
the patient had a history of menorrhagia for several months and over the course of this hospitalization, her hemoglobin levels dropped below 7 cells/mm3 for which she required transfusion. This prompted further investigation with CT of the abdomen and pelvis, which revealed marked enlargement of lobulated uterus with suspicion of mass effect on the inferior vena cava (IVC) and iliac veins. An MRI of the abdomen confirmed compression by her fibroids on the IVC. Decision was made to proceed with hysterectomy to address both the symptomatic fibroids and the associated DVT. Postoperative histopathology confirmed benign fibroids. Discussion: This case emphasizes the intricate relationship between anatomical anomalies, like uterine fibroids that can potentially lead to IVC compression resulting in an increased risk for thrombosis leading to DVT formation in the absence of typical risk factors, emphasizing the need for thorough clinical assessments. The
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