Clinical History

The patient is a 46-year-old man with a history of Lupus and hypothyroidism who presented to the hospital after suddenly developing expressive aphasia where he began “speaking gibberish”. He is being treated for Lupus by a doctor in Mexico. He has no history of tobacco, alcohol, or illicit drug use.

Vital signs were heart rate 101, respirations 14, blood pressure 144/74, and temperature 39C (102.2F).

Initial physical exam findings showed that the patient is alert and awake. Patient is lucid and able to follow commands. He had no additional neurologic deficits aside from expressive aphasia. There was petechiae noted around his right upper extremity under the blood pressure cuff. The remaining physical exam is unremarkable. A head CT showed no evidence of infarct or hemorrhage. While waiting for the brain MRI, his neurologic status began to deteriorate.


Labs

Chemistry Panel

  Patient Reference
Sodium 135 135 - 145
Potassium 3.7 3.3 - 5.0
Chloride 107 95 - 110
Carbon dioxide total 20 24 - 32
Urea nitrogen 23 8 - 22
Creatinine Blood 1.43 0.44 – 1.27
Glucose 87 70 - 99
Calcium 7.3 8.6 – 10.5
Bilirubin total 1.9 0.3 – 1.3
Lactate dehydrogenase 552 90 - 200
Haptoglobin 6 10 - 210

Complete Blood Count

  Patient Reference
White blood cell count 4.0 4.5 – 11.0
Red blood cell count 2.76 4.5 – 5.9
Hemoglobin 8.2 14 – 18
Hematocrit 23.8 40 - 52
MCV 86.3 80 - 100
MCH 29.8 27 - 33
MCHC 34.5 32 - 36
RDW 16.1 0 – 14.7
Platelet count 38 130 - 400
MPV 7.5 6.8 - 10

Peripheral Blood Smear:

Peripheral Blood Smear

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