Suzanne Tobin, had been driven by her partner, James Rapp, from their Germantown home to the Hopkins ER in hopes that doctors there could determine what was causing her relentless deterioration. The first sign of a problem occurred in July 2013, when Tobin noticed a droop on the left side of her face, accompanied by slightly slurred speech. Now she could no longer walk unassisted, her speech was nearly unintelligible and her left hand was so weak she could no longer hold a book. Doctors in suburban Maryland had diagnosed a stroke -or possibly a series of strokes - but were unable to explain why Tobin kept getting worse by the week. An MRI showed evidence of lesions in the brain’s white matter, which controls overall function, suggestive of a prior stroke. Sometimes her blood pressure was deemed too high for PT. A new round of brain MRIs showed additional white matter lesions, a sign of further neurological injury. A spinal tap failed to find an infection. Multiple sclerosis, ALS, Lyme disease, and lymphoma had been ruled out. Tobin’s CD4 count, which measures a type of white blood cell that fights infection, was an alarmingly low 31; normal counts range from 500 to 1,500. Can you find out the cause?
Clue 1: It was not Lyme disease.
Clue 2: Tests ruled Amyotrophic lateral sclerosis (ALS) and Multiple sclerosis.
Clue 3: Atrial fibrillation was not the cause.
Clue 4: Doctors couldn’t find any malignant brain tumor or a blood clot.
Clue 5: Tobin did not have HIV or AIDS.