A 90-year-old patient with a history of colonic diverticular disease, gastroesophageal reflux and visual and auditory sensory deficits.
User of eszopiclone routinely.
In the integrated assessment performed at admission to the hospital, it was described as autonomous in advanced activities of daily living and without cognitive impairment.
She was admitted to the emergency department due to intense holocranial headache, temporal-spatial disorientation and sudden psychomotor agitation in the last 24 hours.
Their relatives did not report fever, nausea or vomiting.
Physical examination revealed regular tachycardia, hypertension and absence of neurological focalization.
Computed tomography scan of the brain revealed an inversion and atheromatosis in the vertebrobasilar system.
There were no signs of infarction or bleeding.
Laboratory tests showed no metabolic or hydroelectrolytic alterations and C-reactive protein was in normal concentration.
The patient was evaluated by a neurologist who described the presence of delirium and a probable left hemianopsia suspecting a right ischemic stroke.
The next day it is described that the patient did not present delirium, hemianopsia was ruled out in a new neurological examination.
During the day she presented with fevers up to 37.5°C. On the fourth day of hospitalization she developed delirium again.
A control brain computed tomography showed no changes; however, C-reactive protein increased (125 mg/L) and mild leukocytosis appeared.
The next day a fever of 38°C appeared. The patient suffered an infectious episode. A chest X-ray, urinalysis, urinalysis, hemocultive tests and obtaining cerebrospinal fluid through a lumbar puncture were normal or negative.
An evaluation by an infectologist suggested using empirical antibiotic therapy, prescribing ceftriaxone and ampicillin.
The persistence of delirium and the increase in inflammatory parameters on the fourth day of antibiotic therapy motivated the performance of computed tomography of the chest, abdomen and pelvis and an abdominal ecotomography, without signs that only showed rejection.
Two days later the patient presented volume increase in the left knee with inflammatory signs.
Joint puncture yielded a slightly turbid yellow fluid with viscosity < 0.1.
Cell count was 360 leukocytes per field, with 60% polymorphonuclear.
Gram and bacterial culture were negative.
An X-ray of the knee showed calcification of the articular cartilage consistent with chondrocalcinosis.
It was concluded that the febrile syndrome, elevated inflammatory parameters, delirium and monoarthritis of the knee with the characteristics of the articular fluid described were caused by a pseudogout crisis.
No joint fluid analysis was performed for crystal search because the hospital emergency laboratory did not have this method.
Antibiotics were discontinued and therapy with celecoxib and colchicine was initiated.
Fever, delirium, and arthritis resolved within 48 h.
The patient was discharged after 13 days of hospitalization in good general condition and in subsequent controls he was in the condition that he had prior to the disease that led to hospitalization.
