We report the case of a 27-year-old Chinese woman, who did not understand Spanish, without known drug allergies, or medical and surgical history of interest and correctly vaccinated during childhood in her country of origin.
The patient came to the emergency room for the first time due to a pruritic urticariform reaction of 24 hours of evolution.
In this first consultation, an intramuscular antihistamine and delayed-release corticosteroid were prescribed, and the patient was diagnosed with urticaria.
One day later, the patient came back to the emergency department due to an increase in the number of lesions, reporting intense itching of the face, scalp, trunk, upper limbs and genitals.
Several polymorphous lesions of widespread dispersed distribution are observed, with hemorrhagic crusty lesions and other vesiculo-pustular lesions of two to five millimeters in diameter, some of them umbilicated in central zone.
In the mid-abdominal region, the patient reported necrotic crusted lesion that had been manipulated.
After examination, she was diagnosed with chickenpox.
We proceeded to rule out complications by auscultation and request of chest X-ray that was completely normal, so after taking the smears of lesions he was taken home explaining the measures of respiratory isolation that it was convenient not to take with his.
Oral radiation therapy 800 mg every four hours, five times a day, with night rest seven days and antihistamines was prescribed.
Seven days later, our patient came to the emergency department of our reference hospital due to intense asthenia of 24 hours duration with no other symptoms.
The examination was completely normal, so in the absence of both analytical and radiological alterations, the patient was discharged home.
Twelve hours later, the patient returned to the emergency department with suprapump pain and asthenia.
The anamnesis revealed dysuria of two days of evolution as well as oligoanuria, without concomitant fever.
Cardiopulmonary auscultation was totally normal.
Abdominal examination revealed pain consistent with bladder balloon obstruction in both renal fossae.
Due to the suspicion of acute urinary retention, a urinary catheter was performed, confirming a voiding cyst of 1,200 cc.
Blood and urine tests were performed with results within normal parameters.
An abdominal X-ray showed abundant retained fecal remnants.
During reassessment in the observation room, the translator-companion reported a clear improvement in abdominal pain and expressed that the patient complained of progressive loss of strength and weakness of the lower limbs for four days.
The patient was reevaluated, highlighting marked cervical rigidity, normal cranial nerves, motor balance 5/5 distal and proximal in upper extremities.
In lower limbs, paraparesis developed with proximal 3/5 and distal 4/5 motor balance.
Located with bilateral osteotendinous hyporeflexia and abolition of ankle reflexes.
Cutaneous plantar foot in bilateral flexion.
Metformin sensitivity below D5 (mechanism).
The presence of white matter of neurological alterations was indicated to perform a normal cranioencephalic computerized axial tomography (CAT) where focal intracranial lesions and the spaces of cerebrospinal fluid were not observed.
Subsequently, a lumbar puncture was performed where clear liquid was observed and samples were taken for laboratory study entering the Neurology service with the diagnosis of suspected incomplete transverse myelitis post-infectious.
During admission, a spinal magnetic resonance imaging (MRI) was performed, showing an area of hypersignal on T2 located at the level of the cervical medullary cord (C5-D1) with a very small dilation of the myelim
The lesion showed mild hypointensity on T1.
All this confirmed the diagnosis of infectious myelitis in the cervical spinal cord.
1.
The results of CSF serology for Borrelia, Brucella, syphilis, Epstein (VEVster) virus, Cytomegalovirus (CMV), Herpes simplex virus (HAV) and Varenicella
Serum serology results were consistent with CSF, except for Varicella Zoster virus, which was positive.
Serology was also requested Human Immunodeficiency Virus with negative result.
Therefore, the etiological diagnosis of high probability was acute myelitis due to infection Varicella Zoster virus (VZV).
Since admission due to the high suspicion of acute myelitis caused by VZV, treatment was initiated with iv corticosteroid during the first ten days associated with IV corticosteroid.
The patient experienced a slow but constant improvement, finally and after one month of admission, the catheter was removed without presenting any episode of acute urinary retention in the following days.
At discharge, rehabilitation treatment continued.
