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[Clinical reasoning and decision-making in practice. A young woman with fever, shortness of breath, and reduced consciousness].
Ned Tijdschr Geneeskd. 2003 Jul 19; 147(29):1404-8.NT

Abstract

A 23-year-old woman with mild psychomotor retardation presented with fever, coughing, reduced consciousness and a stiff neck. A chest X-ray revealed an infiltrate in the left lower lobe; the cerebrospinal fluid was cloudy with a mild pleocytosis. Ceftriaxone was prescribed and the fever subsided. On the second day of admission she had a seizure, and a paraparesis emerged. Despite changes in the antibiotic regimen, her clinical condition hardly improved. On the fifth day, antibodies against Mycoplasma pneumoniae were found to be strongly positive and the diagnosis was M. pneumoniae infection. This accounted for the pneumonia together with meningoencephalitis and a transverse myelitis. The antibiotics were switched to doxycycline and the clinical condition improved dramatically. Six weeks after discharge, the patient had made a complete recovery. In patients suffering from meningitis with an atypical presentation, uncommon causes of infection should be considered. Together with a pneumonia, M. pneumoniae, Chlamydia pneumoniae, Legionella pneumophila and Listeria monocytogenes should be high on the list of potential causes for bacterial meningitis.

Authors+Show Affiliations

Medisch Centrum Haaglanden, locatie Westeinde, afd. Neurologie, Lijnbaan 32, 2512 VA Den Haag.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

dut

PubMed ID

12894464

Citation

Taal, W, et al. "[Clinical Reasoning and Decision-making in Practice. a Young Woman With Fever, Shortness of Breath, and Reduced Consciousness]." Nederlands Tijdschrift Voor Geneeskunde, vol. 147, no. 29, 2003, pp. 1404-8.
Taal W, Kauffmann RH, Hart W, et al. [Clinical reasoning and decision-making in practice. A young woman with fever, shortness of breath, and reduced consciousness]. Ned Tijdschr Geneeskd. 2003;147(29):1404-8.
Taal, W., Kauffmann, R. H., Hart, W., & Vecht, C. h. J. (2003). [Clinical reasoning and decision-making in practice. A young woman with fever, shortness of breath, and reduced consciousness]. Nederlands Tijdschrift Voor Geneeskunde, 147(29), 1404-8.
Taal W, et al. [Clinical Reasoning and Decision-making in Practice. a Young Woman With Fever, Shortness of Breath, and Reduced Consciousness]. Ned Tijdschr Geneeskd. 2003 Jul 19;147(29):1404-8. PubMed PMID: 12894464.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Clinical reasoning and decision-making in practice. A young woman with fever, shortness of breath, and reduced consciousness]. AU - Taal,W, AU - Kauffmann,R H, AU - Hart,W, AU - Vecht,Ch J, PY - 2003/8/5/pubmed PY - 2003/12/12/medline PY - 2003/8/5/entrez SP - 1404 EP - 8 JF - Nederlands tijdschrift voor geneeskunde JO - Ned Tijdschr Geneeskd VL - 147 IS - 29 N2 - A 23-year-old woman with mild psychomotor retardation presented with fever, coughing, reduced consciousness and a stiff neck. A chest X-ray revealed an infiltrate in the left lower lobe; the cerebrospinal fluid was cloudy with a mild pleocytosis. Ceftriaxone was prescribed and the fever subsided. On the second day of admission she had a seizure, and a paraparesis emerged. Despite changes in the antibiotic regimen, her clinical condition hardly improved. On the fifth day, antibodies against Mycoplasma pneumoniae were found to be strongly positive and the diagnosis was M. pneumoniae infection. This accounted for the pneumonia together with meningoencephalitis and a transverse myelitis. The antibiotics were switched to doxycycline and the clinical condition improved dramatically. Six weeks after discharge, the patient had made a complete recovery. In patients suffering from meningitis with an atypical presentation, uncommon causes of infection should be considered. Together with a pneumonia, M. pneumoniae, Chlamydia pneumoniae, Legionella pneumophila and Listeria monocytogenes should be high on the list of potential causes for bacterial meningitis. SN - 0028-2162 UR - https://www.unboundmedicine.com/medline/citation/12894464/[Clinical_reasoning_and_decision_making_in_practice__A_young_woman_with_fever_shortness_of_breath_and_reduced_consciousness]_ L2 - https://medlineplus.gov/antibiotics.html DB - PRIME DP - Unbound Medicine ER -