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Mansize 'guess the diagnosis'

76 yo female presenting with fall. Diagnosed with UTI in ED by EM SHO and medical SHO. At that time bloods normal except mildly elevated ALT of 150, urine dip 2+ blood, neg nit, neg leu. Pt has no complaints but said has been feeling a bit weak for last few days.
Had been found on floor unable to get up after lying there for 45 mins only.
Nil fractures on x-ray.
2 days after admission Dr Awesome comes to work. Notes bloods show Cr rise from 70 to 110, ALT from 150 to 350. Other LFTs normal, CRP 25.

Realises previous diagnosis is rubbish and after a 2 minute examination comes up with a new diagnosis proven by one blood test.

Guess the diagnosis and test :wink:

Reply 1

Wangers

Endocartitis + culture?

Reply 2

Renal

I was thinking along the lines of a myositis?

Reply 3

Madprof

Rhabdomyolysis (poss statin-induced as wasn't on floor very long plus was feeling weak before fall?) and test blood for CK.

(edited 13 years ago)

Reply 4

Magendie

I think it's Rhabdomyolysis and CK too

(edited 13 years ago)

Reply 5

Daveo

hmm, agree with above but suspect it must be something more cool

Reply 6

xXxBaby-BooxXx

I really hope it is rhabdomyolysis, because if it is then that's the first diagnosis I have got right :biggrin:

Reply 7

Wangers

wou;dn'y you do U+E for rhabdo - potassium? Or is CK that good on its own?

Reply 8

SMed

If it's rhabdo, CPK is a better test, but I guess CK would still be useful.

(edited 13 years ago)

Reply 9

Renal

Original post by Wangers

wou;dn'y you do U+E for rhabdo - potassium? Or is CK that good on its own?

You'd need to do other tests but CK would be diagnostic.

Reply 10

RetiredAccount89

CK is the right test, but it isn't rhabdo.
It was infact polymyositis. (well done renal!!)
She was only on the floor for 30mins!

The 2 min exam I did was of her power, and showed 3/5 power proximally, but 4-5 distally. normal sensation.
The ALT rise is because it is in muscle as well as liver (hence why other liver enzymes normal) and the blood in urine was actually myoglobin (proven by sending urine off to look for it/red cells).
Her CK came back as 50,000

Normally you would confirm diagnosis by mri thighs (STIR weighted it will show up bright white in areas of myositis) and then biopsy the affected muscle groups. EMG studies as well
Treatment with very high dose steroids (methylprednisolone IV) and then immunosuppression.

Unfortunately in this case she got transferred away from my care to the care of incompetent jackasses who couldn't fluid balance a potted plant, went into crashing renal failure so had to be treated without definitive tests (MRI +ve, no biopsy/EMG performed). But the rheumatologist agreed with diagnosis.