Altered mental status can have many causes ranging from emergent intracranial pathologies to more insidious, systemic toxic aetiologies. We report a rare case of dermato-neuro syndrome in a 71-year-old man with a known history of scleromyxoedema. The patient initially presented with encephalopathy which quickly progressed to generalised tonic–clonic seizures and coma. While his presentation fits with other, although rare, cases of dermato-neuro syndrome, it is imperative to rule out lethal, more common causes of altered mentation. Due to the rarity and difficulty in diagnosis of dermato-neuro syndrome, there is a significant debate regarding the optimal management as there are no standardised treatment protocols. In our case, the patient was successfully treated with plasmapheresis resulting in improved neurologic function.
- coma and raised intracranial pressure
- haematology (incl blood transfusion)
- adult intensive care
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Contributors JML is a resident physician training in internal medicine. He contributed to the critical care of this patient, is the primary author and contributed to the formation and revision of this manuscript. JC is a fellow in haematology and oncology. She contributed to the critical care of this patient and also contributed to the formation and revision of this manuscript. TSV is a fellow in pulmonary and critical care medicine. He contributed to the critical care of this patient, provided the pictures of the scleromyxoedema rash and contributed to the revision of this manuscript. SL is an attending physician in haematology/oncology. She is the senior author of this manuscript, contributed to the treatment of the patient and also contributed to the content, structure and revision of this manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.