Case Report
Rare Cause of Seizures, Renal Failure, and Gangrene in an 83-Year-Old Diabetic Male
Table 1
Lab investigations of patient.
| | Day of admission | 1 | 4 | 5 | 7 | 10 | 16 | 18 |
| | Urea (2.5–7.1 mmol/L) | 67.8 | 61.7 | 47.1 | 38.7 | 33.2 | 26.4 | 21.1 | | Creatinine (44–80 mol/L) | 616 | 422 | 360 | 281 | 290 | 202 | 167 | | HbA1c (5.7–6.5%) | 7.9 | | | | | | | | Bil total (1.7–6.8 mol/L) | 1.53 | | | | | | | | Bil dir (3.4–15.2 mol/L) | 8.5 | | | | | | | | SGOT (0.20–0.65 kat/L) | 1.5 | | | | 1.4 | | | | SGPT (0.12–0.70 kat/L) | 0.87 | | | | 0.92 | | | | ALP (0.56–1.63 kat/L) | 3.88 | | | | 9.02 | | | | Protein (67–86 g/L) | 63 | | | | | | | | Albumin (40–50 g/L) | 18 | 21 | 22 | 22 | | | | | GGT (0.15–0.99 kat/L) | 4.48 | | | | | | | | K+ (3.5–5.0 mmol/L) | 5.6 | 3.3 | 3.9 | 3.2 | 145 | 137 | 138 | | Na+ (136–146 mmol/L) | 155 | 151 | 150 | 143 | 5.7 | 3.8 | 3.2 | | Calcium (2.2–2.6 mmol/L) | 2.2 | | | | | | | | Mg (0.62–0.95 mmol/L) | 0.78 | | | | | | | | Pi (0.81–1.4 mmol/L) | 1.45 | | | | | | | | LDH (114–240 IU/L) | 506 | | | | 269 | | | | CK (25–200 U/L) | 363 | | | | 103 | | |
| | Urine | | | | | | | | | Spot K+ (25–120 mEq/L) | 30.5 | | Spot Na+ (40–220 mEq/L) | 116 | | Bence-Jones | Negative | | Myoglobin | Negative | | Heme | Negative | | Eosinophils | Negative | | Culture | 3 organisms | | Stool occult blood | Negative | | Endotracheal asp AFB | Negative | | Endotracheal asp culture | Pseudomonas | | Hb (130–160 g/L) | 81 | | TC (3.50–/L) | 10.2 | | Neutrophilia (%) | 81 | | Plat (165–41/L) | 100 | | MCV (79–93.3 fL) | 77 | | MCH (26.7–31.9 pg) | 27.8 | | MCHC (323–359 g/L) | 358 | | Reticulocyte (%) | | | | 0.5 | | | | | INR | | | | 1.3 | | | | | aPTT (control 25.1 s) | | | | 40 | | | | | D dimer (200 ng/mL) | | | | 3200 | | | | | FDP | Positive | | Blood cultures | Sterile | | dsDNA (<20) | 28 | | ANA (<1.0) | 1.8 | | cANCA | Negative | | C3 (0.83–1.77 g/L) | 0.78 | | C4 (0.16–0.47 g/L) | 0.20 | | Cortisol (5–25 g/dL) | 26.1 | | Ferritin (28–397 ng/L) | 1328 | | Direct Coombs | Negative |
| | Cerebrospinal fluid | | | | | | | | | Cells | 103 | | Sugar (mg) | 115 | | Protein (<60 mg) | 39 | | Lymphocytes (<5) | 100% | | ADA | 1.0 | | AFB | Negative | | Gram | Negative | | India ink | Negative |
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HbA1c: glycated haemoglobin; bil: bilirubin; dir: direct; SGOT: serum glutamic oxaloacetic transaminase; SGPT: serum glutamic pyruvate transaminase; ALP: alkaline phosphatase; GGT: gamma-glutamyl transferase; K+: potassium; Na+: sodium; Mg: magnesium; Pi-inorganic phosphate; LDH: lactate dehydrogenase; CK: creatine kinase; Hb: haemoglobin; TC: total cells; plat: platelets; MCV: mean corpuscular volume; MCH: mean corpuscular haemoglobin; MCHC: mean corpuscular haemoglobin concentration; INR: international normalized ratio; aPTT: activated partial thromboplastin time; FDP: fibrinogen degradation products; dsDNA: double-stranded DNA; ANA: antinuclear antibody; c-ANCA: antineutrophil cytoplasmic autoantibody; C3: complement C3; C4: complement C4; ADA: adenosine deaminase; AFB: acid-fast bacilli; asp: aspirate.
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