PAULA Davis, MD, Senior Assistant Resident in Medicine, the Jewish Hospital of St Louis: A 26-year-old woman was admitted for the first time at the Jewish Hospital for evaluation of a seizure disorder, weakness, hypertension, and possible tularemia. In August 1981, the patient was hospitalized because of fatigue and aching pain in the lower part of the abdomen. She underwent a salpingo-oophorectomy on the left side for an ovarian cyst. As a teenager, she had had a salpingo-oophorectomy on the right side and an appendectomy for the same reason. Before surgery, she had her first seizure several hours after receiving a preparation containing sulfur, and phenytoin sodium therapy was initiated, with effective control of her seizures.
She was hospitalized again in November 1981 for continuing fatigue, weight loss, myalgias, and abdominal aching. Her BP was 160/110 mm Hg, and her serum sodium level was 127 mEq/L. Her history disclosed that