[Expert Solution]: Ms

Ms. River Memes is a 45 year female with past medical history of Myelodysplastic syndrome and Reynauds syndrome, (per outside records) kidney stones and endometriosis, depression, anxiety , previously charted as taking lithium, history of seizures during a stressful time, off Keppra for 3 years without seizures, who presented to the emergency room last month with several days of weakness and confusion after having COVID 2 weeks ago. Per family they were giving her water with a dropper because of poor appetite and weakness. She initially endorsed difficulty swallowing, but later denied. She also had 3 episodes of diarrhea day prior to presentation. Review of system otherwise negative except for diffuse weakness and confusion. She reports urinating on herself and diarrhea in bed due to inability to get to bathroom fast enough. Denies sensory loss in groin. Mother states recent stressful episode of close relative passing away. Myelodysplastic syndrome diagnosed in 2019. Marrow from 01/2016 showed trilineage mild dysplasia with mild megakaryocytic hyperplasia. She was lost to follow-up until 2021 when she was seen by Hematology again