| QUIZ: Atypical pneumonia? *solved* |
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| Saturday, 31 October 2009 00:15 |
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Case description: 48 years old man came to a GP to have a check-up after macrolides therapy for a dry cough which he had for two weeks. The cough was gone but he started feeling his muscles weakening in lower limbs, cramps and began to have a double vision. He is still generaly weak. Auscultation: sharpened alveolar murmurs, single additional contractions. ECG: single supraventricular contractions QUIZ questions: What other tests should be done to eventually verify differential diagnoses? What's with patient?
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Comments
I would ask for HIV tests as well.
heart echo: mitral insufficiency - hemodynamicly insignificant
HIV-1, HIV-2 - negative
X-ray: status after VI rib fracture
Cultures: negative (during antibiotics therapy?)
I suggest:
- antibodies versus Mycoplasma antigens in IgM and IgG class
- neurological examination - deep reflexes
- cerebrospinal fluid leak test, EMG eventually to exclude Guillain-Barry syndrome
Antibodies in high level, IgG especially
In neurological examination: symmetrical weakness of deep reflexes of lower limbs, sens disorder, weakness of oculomotor muscles
EMG: slowed down conduction, elongated F wave latency
treatment: immunoglobulins and plasmaferesis should be considered, macrolides should be taken till the end of cycle.
monitoring: pressure, EKG, EMG, neurological examinations
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