1992 - diagnosed pulmonary tuberculosis and completed antiTB apparently . Had recurrent chest infection since then and diagnosed mediastinal thymoma.
2002 - symptomatic anaemia (Hb 2.88g /dl). Diagnosed red cell hypoplasia by bone marrow examination. Given IV Immunoglobulin prior to thymoma removal. Thymoma removed on 27/8/2002. HPE: benign thymoma. Anaemia recovered fully with IV IG.
Since 2004 -recurrent admission for chest infection.
Dec 2005 - contrast enhanced computered tomography (CECT) thorax-no significant findings.
Dec 2006 - high resolution computed tomography (HRCT) thorax-minimal fibrosis & mild bronchiole dilatation in left upper and lower lobe. TB work up were negative in both 2005/2006.
Dec 2009- presented with rash for one month. She was emaciated with generally dry skin and had photodistributed maculopapular eruption and erythematous plaque on nose. She had multiple excoriations and excoriated papules as well and we saw a vesicle. We biopsied again and investigated for connective tissue disease but negative.
July 2010 - ENT clinic:
complaint of dysphagia to solid food x 6/12
Nasal regurgitation for fluid x 6/12
Hoarseness of voice x 3/12
Multiple skin lesions x 1 year.
O/E: gag reflex present
Left vocal cord palsy, right vocal cord impaired motility.
pooling of saliva. Advised for ryles tube feeding but patient declined till now.
Skin biopsy: a skin vesicle show multinucleated giant cell, balloon degeneration suggestive of HSV infection and the lesion were recurrent.
We had investigated her for polymyositis and sarcoidosis. CK and calcium were normal. She was given prednisolone for a short while for the suspected sarcoidosis. Subsequently developed right eye blurring of vision. Ophthalmology impression: ?CMV retinitis.Unable to send vitreous for CMV viral load due to logistic limitations.
Given intravitreal gancyclovir repeatedly till now and IV Gancyclovir at least twice (each time 2 weeks). Initially improved slightly based on ophthalmologist opinion but subsequently deteriorated quickly. Now R eye blind, left eye vision hand movement only and is rapidly deteriorating. On monthly gancyclovir intravitreal injection.
4/8/2010 - OGDS-normal, no evidence of ulcer.
Now - recurrent and frequent incapacitating chest infection. (CT thorax previously showed pulmonary fibrosis.) Severe weight loss. Now almost skin and bone only and has been wheel chair bound for a few months due to severe wasting. Also has small hand muscle wasting bilaterally. Given monthly IV immunoglobulin-since Mar till now.