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Washington University Experience | INFECTION | Bacteria | Mycoplasma | 1A0 Case 1 History
Case 1 History ---- The decedent was a 26 year old woman with a history of migraines, fibromyalgia, and possible IV drug use who presented with fever (104.2oF) altered mental status and seizures. LP was essentially normal, CSF was HSV-I negative. Over the next week she continued to have altered mental changes without identification of an etiology following exhaustive testing. Negative/normal labs included: thyroperoxidase antibody, HIV, HCG, ESR, ENA, ANA, dsDNA, cortisol, ANCA, paraneoplastic autoantibody panel, West Nile virus, ceruloplasmin, carnitine, RPR, Hep C, Coccidioides AB, Blastomyces, Bartonella, Hep A, Hep B, CSF gram stain/culture, CSF viral cultures (CMV, EBV, HHV-6, JC Virus, Enterovirus, HSV, Parvovirus, and VZV). CSF testing for tau protein and 14-3-3 were positive but, ultimately, using Western blot and immunohistochemistry provided by the National Prion Disease Surveillance Center (NPDPSC), was inconsistent with CJD (i.e., a false positive result). An EEG showed numerous subclinical seizures. Her myoclonus improved with the medications, however mental status did not improve. Multiple MRIs during her hospitalization showed T2 and FLAIR hyperintensities involving the parietal, occipital, temporal lobes and the pulvinar of the thalami. There were gyriform T1 hyperintense laminar necrosis of the parietal and occipital lobes, as well as midline shift and downward descent of the cerebellar tonsils. Care was redirected and she died after a total course of 3 months.
