An 18-year-old male patient with a history of a trip to the city of Bariloche two weeks prior to hospitalization, after which he presented rhinosinusitis.
She received 500 mg/day NS for five days with complete resolution of symptoms.
Subsequently, he developed fever, headache, confusional syndrome and myoclonus.
A brain CT scan (CT) was performed and laboratory tests showed normal function, ionogram, liver tests, glucose, urea, creatinine, magnesium, calcium, phosphorus, creatinekinase, thyroid sedimentation rate) sediment.
Urine toxicology was positive for cannabis on two occasions.
Lumbar puncture (LP) showed cerebrospinal fluid (CSF) rock crystal with mononuclear pleocytosis (109 mm3) and hyperproteinorrhachia (1.6 g/dl).
CSF analysis for leptospira, whole virus, Herpes simplex virus, Herpes 6 and 7, varicella zoster, St Louis encephalitis, mycoplasma, syphilis and tuberculosis yielded negative results.
Blood cultures, urine cultures, serology for hepatitis, human immunodeficiency virus, cytomegalovirus, and parvovirus B were negative 19.
Nasopharyngeal swab was negative for respiratory viruses.
Antinuclear factor, complement, anticardiolipin antibodies and latex were determined with normal results.
Epidermitis was defined as < 1:170.
Treatment was initiated with ceftriaxone, vancomycin and arsenic.
After 48 hours of hospitalization, the patient developed a posture of deterioration of the mechanical sensing, requiring respiratory assistance.
The electroencephalogram (EEG) showed diffuse base rhythm lonification and subsequently used levetiracetam with bilateral epileptiform activity compatible with daily status epileptiform activity at a seizure rate of 30 mg/ valproic acid.
He was discharged five days later with good tolerance.
He had fever in the context of pleural effusion (non-complicated exudate with negative culture).
On the tenth day he presented rigidity and progressive branesia, adding rest tremor to 6Hz.
Brain CT was repeated and showed no changes with respect to the previous study.
Brain magnetic resonance imaging (MRI) showed hyperintense images in FLAIR sequence (Fluid attenuated investment recovery) and T2 in both insular cortex with right predominance of unenhanced glin administration.
The clinical picture was interpreted as post-encephalotic parkinsonism and L-dopa was started.
The patient remained with fever, generalized tremors and stiffness, with minimal response to L-dopa/carvidopa used at a rate of 4 daily tablets of 100/25 mg administered every 3 h.
A negative apomorphine test was performed.
A dose of L-dopa up to 1,000 mg/day was increased in 4 doses of 250/25 mg separated by 3 h.
Lumbar puncture, urocultive, hemocultive, chest X-ray and Clostridium dijficile toxin were repeated in stool, all with normal results.
1.
He continued with extreme rigidity, catatonia, cranial flexibility and mutism.
Days later he presented paradoxical kinesynesia, for which the patient showed signs of understanding orders but was unable to perform motor acts; when throwing a balloon on his face, however, he was able to take it with both hands.
A nasoenteral feeding tube was placed because the patient had lost 15 kg during hospitalization.
LD possibility. pulses of methylprednisolone were administered at a dose of 1 g per day for 5 consecutive days, subsequently continuing with meprednisone 40 mg with drastic improvement in rigidity first
During the entire hospitalization, an intensive psychiatric rehabilitation and speech therapy were performed.
Due to the development of adverse effects caused by L-dopa (conditions) doses were reduced and brain MRI was repeated, which was similar to the previous one with negative diffusion.
EEG showed no epileptiform activity.
He was discharged to continue rehabilitation in a third level center with the following medication: levetiracetam 1,500 mg/day, L-dopa 250/25 mg three times a day and meprednisone in escalation.
The patient remains in outpatient follow-up, presenting with seizures and minimal cognitive impairment one year after the event.
