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A previously healthy girl aged 15 years presented with a 3-month history of low back pain, lethargy, morning stiffness and nocturnal back discomfort. She had no significant history of weight loss, infective symptoms or neurological symptoms, including bladder or bowel incontinence. There was no recent travel history. Examination revealed normal temperature and mild focal tenderness over the midline lumbar spine, with normal range of motion. There was isolated weakness in left hip flexion, and no other neurological findings. Blood tests showed a normal white cell count (6.6×109/L), elevated erythrocyte sedimentation rate (38 mm/hour) and slightly elevated C reactive protein (11 mg/L, normal

We present a case of a previously healthy 64-year-old man who presented initially with chest pain and inferior ST elevation acute coronary syndrome. Primary angiography revealed minor left coronary disease and an occluded proximal right coronary artery. Oral loading doses of aspirin 300 mg and prasugrel 60 mg were prescribed. Given significant thrombus burden, intravenous weight-adjusted glycoprotein IIb/IIIa inhibitor abciximab (0.25 mg/kg) and unfractionated heparin (70 units/kg) boluses were given and a 6 Fr Export (Medtronic, Minnesota, USA) aspiration catheter restored thrombolysis in myocardial infarction III flow. Two resolute integrity (Medtronic, Minnesota, USA) drug-eluting stents were successfully deployed. Chest pain and ECG changes resolved, and abciximab infusion (0.125 µg/kg/min) was continued for 12 h. The next morning, the patient developed severe lower back pain with urinary retention, loss of anal sphincter tone, bilateral lower limb areflexia, grade 0 power deficits and T12 …