title: Catastrophic chest pain: blinded by cardiopulmonary disease.
abstract: A 53-year-old man with a history of diabetic foot ulcer, osteomyelitis, coronary artery disease, hypertension and hyperlipidaemia, presented with chest pain of 3 weeks duration. Eleven days earlier, the patient had had a drug-eluting stent (DES) placed in a branch of the right coronary artery (RCA) after similar chest pain, leading to the findings of a positive nuclear stress test. Since discharge, he was not compliant with taking clopidegrel (Plavix), a concern for in-stent thrombosis with recurrent myocardial ischaemia; but work up was negative and medications were restarted. Within 24 h of admission, he developed bilateral flaccid leg weakness, urine retention and loss of sensation from the umbilicus level down. MRI revealed a T4-T6 epidural abscess. Emergent decompression laminectomy and abscess drainage was completed. Neurological symptoms improved hours after surgery with complete resolution of sensory deficits. Cultures grew Streptococcus sp., treated with intravenous nafcillin for 8 weeks. He regained leg strength with continued improvement seen in rehabilitation.
authors.affiliation: Department of Pulmonary, Critical Care and Sleep Medicine, NEOMED, Rootstown, Ohio and OUHCOM, Athens, Ohio, USA Department of Pulmonary, Critical Care & Sleep, HMHP, Younstown, Ohio, USA.
authors.forename: Timothy John
authors.initials: TJ
authors.lastname: Barreiro
authors.affiliation: Department of Internal Medicine, Mercy Health System, Youngstown, Ohio, USA.
authors.forename: Denis D
authors.initials: DD
authors.lastname: Asiimwe
authors.affiliation: Department of Internal Medicine, Mercy Health System, Youngstown, Ohio, USA.
authors.forename: David
authors.initials: D
authors.lastname: Gemmel
authors.affiliation: Department of Internal Medicine, Mercy Health System, Youngstown, Ohio, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brine
mesh_terms: D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002637:Chest Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003327:Coronary Disease; D019299:Decompression, Surgical; D017719:Diabetic Foot; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D020802:Epidural Abscess / Q000209:etiology* / Q000601:surgery; D006801:Humans; D006973:Hypertension; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009254:Nafcillin / Q000008:administration & dosage*; D010019:Osteomyelitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D009254:Nafcillin