Case Report

A 44-year-old woman with a history of triple-negative breast cancer metastatic to the brain presented with changes in mentalstatus, lower back pain, and a left facial Bell’s palsy.

The patient had previously been ambulatory and fully cognizantof her surroundings until one week prior to presentation when she began to exhibit progressively worsening confusion. As hermental status began to change, the patient developed new onsetpain over her lumbar spine, supra-pubic area, bilateral flanks, hips, and knees. The pain was refractory to an epidural injectioninto her lumbar spine performed at the patient’s local hospital. Other complaints included a recent onset urinary retention, weakness of the left lower extremity, a left facial Bell’s palsy, and difficulty walking. On admission, the patient was taking gabapentin, citalopram, aspirin, enoxaparin, nystatin, lopressor,docusate, lorazepam, and methylprednisone. The patient was treating her pain with hydromorphone hydrochloride as needed.No other medications had recently been prescribed.