A 24-year-old man from Curicó with a history of migraine in the last year is presented.
In November 2012, the patient was diagnosed with acute otitis media and treated with antibiotics for seven days, with good evolution.
Fifteen days later, the patient developed general malaise, myalgias, headache and fever requiring consultation.
The symptoms were initially interpreted as a flu picture, but the observation of a urinary retention reoriented the diagnosis towards a urinary infection.
A Foley catheter was installed and antibiotic therapy was started that did not improve the condition, even on the second day the relatives noticed commitment of the surveillance, which associated with the generalized weakness of the extremities made them come to the Emergency Department December 1, 2012.
He was admitted oriented, although intellectually slow, with headache and also intense myalgias that generated functional impotence; osteotendinous reflexes present, plantar flexor reflexes and normal sensory base deficit.
Brain tomography (CT) and thoracic spine tomography showed no abnormalities.
Lumbar puncture yielded clear cerebrospinal fluid (CSF) with 47 lymphocytes, with normal glucose and proteins.
Ceftriaxone was started and meningitis was diagnosed.
On the second day of hospitalization, the patient was alert, active, had some cervical pain and moved with difficulty due to myalgia.
CSF was repeated, showing 94 lymphocytes, with normal albumin and glucose, Gram's study was negative; VDRL, ADA and Chinese ink, as well as serology for HBV, HCV, HIV, HTLV were not isolated.
Episodes of colitis and low inflammatory parameters.
On the fourth day of hospitalization, myalgias had improved and CK was 28.
Only urinary retention persisted.
Herpes 6, Enterovirus, Cytomegalovirus, Zoster virus, Parvovirus (IgI and IgG) and Lis Warm were negative by serology.
The search for Mycoplasma showed a positive Ig G and a negative Ig M.
Magnetic resonance imaging defined areas of hyperintensity in the caudal nucleus and putamen, without reinforcement with the administration of intravenous contrast, the spinal cord also presented hyperintensity in the lumbar spine with no enhancement of the cervical medium.
The oligoclonal band study was negative.
The visual evoked potentials were normal.
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On December 18, 2012, CSF control showed clear liquid, with proteins 0.19 g/L, glucose 0.58 g/L, leukocytes 1.6 mm3.
She was discharged in good condition with persistent neurogenic bladder.
On January 15, the patient underwent MRI control, even with a urinary catheter.
The imaging study established the near disappearance of hyperintense cerebral images and the complete regression of the spinal cord images.
