Case 268 -- A Girl in Coma

Contributed by Hazim Najjar, M.D.
Published on line in May 2001


CLINICAL HISTORY:

A 15 year-old girl with unremarkable past medical history found unresponsive near her bed, 5min later she had an attack of tonic/clonic convulsion which lasted one minute with bluish discoloration of lips but no loss of sphincter control. Neither empty bottles nor pills found near her. She was rushed to the Hospital were she was admitted to PICU. Physical Examination was unremarkable apart from deep coma and gross hematuria. CT scan of the head was normal, EEG showed: Alfa wave coma c/w drug intoxication and Echocardiogram showed left ventricular dysfunction and multiple valve leakage.

LABORATORY FINDINGS:

Figure 1 shows the total Ion chromatogram done by gas chromatography on the patient sample. Notice the peak with a retention time of 22.65 min which proved to be PHENYLBUTAZONE (Figure 2) and the peak at 9.81 which proved to be chloroxylenol (Figure 4). Figure 2 Shows the mass spectrum of 22.65 peak which proved to be PHENYLBUTAZONE in the patient specimen compared to the library scan. Figure 3 shows the mass spectrum of Kebuzone in the patient specimen compared to the library scan. Figure 4 shows the mass spectrum of chloroxylenol in the patient specimen compared to the library scan.

Peripheral blood smear:

Bone Marrow Examination:

Done to evaluate for Anemia and Thrombocytopenia to role out aplastic anemia and showed:

FINAL DIAGNOSIS


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