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10: Viral Encephalitis

Ann Lloyd

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PATIENT PRESENTATION

Chief Complaint

Altered mental status and fever

History of Present Illness

GA is a 23-year-old Caucasian female who presents to the emergency department with her parents who report that she has been behaving abnormally over the past several days. They report that she was withdrawn and would not speak. She has complained of a sore throat.

Past Medical History

Depression

Surgical History

None

Family History

Mother with HTN and depression, father with type II DM

Social History

Smokes ½ ppd × 5 years and drinks alcohol socially

Allergies

NKDA

Home Medications

Fluoxetine 40 mg PO once daily

Physical Examination

Vital Signs

Temp 100.4°F, P 141, RR 31 breaths per minute, BP 151/89 mm Hg, pO2 98%, Ht 5′6″, Wt 60 kg

General

Febrile, following limited commands, but in no acute distress

HEENT

+3 tonsils without exudate, normocephalic, atraumatic, EOMI, PERRLA

Pulmonary

Clear to auscultation bilaterally

Cardiovascular

Tachycardic, regular rhythm, no m/r/g

Abdomen

Soft, non-distended, no masses

Neurology

Oriented to person and situation, follows some instructions and nods head but does not speak

Extremities

Warm and dry, no edema, no rashes, ulcers, or lesions

Laboratory Findings

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Na = 129 mEq/L

Hgb = 12.4 g/dL

Ca = 8.6 mg/dL

K = 3.5 mEq/L

Hct = 38%

AST = 26 IU/L

Cl = 97 mEg/L

Plt = 248 × 103/mm3

ALT = 15 IU/L

CO2 = 21 mEq/L

WBC = 13.5 × 103/mm3

T Bili = 0.6 mg/dL

BUN = 13 mg/dL

Alk Phos = 51 IU/L

SCr = 0.88 mg/dL

Glu = 112 mg/dL

CSF Analysis

Colorless, hazy; RBC 0 cells/mm3, WBC 426 cells/mm3, 10% segs, 72% lymphs, 18% monos

CSF Protein

75 mg/dL

CSF Glucose

61 mg/dL

CSF Gram Stain/Culture

Pending

Throat Culture

Pending

CSF Meningitis Panel by PCR (see table for contents of the panel)

Pending

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