Abstract

Fatal Case of Non-culturable Meningitis with Pulmonary Embolism

Author(s): Tracy Butler, Pisespong Patamasucon

A 16-year-old girl with past history of anxiety, depression, and anorexia presents with malaise, fatigue, severe neck stiffness and pain. She also had abdominal pain with non-bilious vomiting which had been worsening for 1 week. Three days earlier she was admitted in our hospital with mono-like symptoms, enlarged liver and spleen, as well as lingual nerve palsy. After consulting with Pediatric Neurology she was treated with steroids and discharged home. However, after discharge she continued to have severe malaise and diffuse body aches, especially in the right upper shoulder and neck. She also had an occipital headache and right sided abdominal pain. During this period she was afebrile. Vital signs: T 36.9 C, RR 22 breaths per minute, Pulse 103 beats per minute, and BP 108/92 mmHg. The work up for her initial presentation includes WBC 5620, 82% neutrophils, 3% bands, 14% lymphocyte, CRP 26.5 mg/dL (nl 0-0.8 mg/dL), D-Dimer 1745 (nl 215-500ng/mL). Other chemistry: Sodium 133 mmol/L, Potassium 3.3 mmol/L, Chloride 103 mmol/L, BUN 20 mg/dL, Creatinine 0.5 mg/dL, Total bilirubin 1.6 mg/dL, AST 37, ALT 58, Alk PO4 160. Upon physical examination, the patient was found to be afebrile, but had stiff neck with enlarged lymph node on the left side. She had no respiratory distress with normal breath sounds, normal heart sounds with tachycardia. Her abdomen was soft and non-tender with no distention and spleen tip was palpable. Neurologically she was alert with equal bilateral reflexes with intact CNS cranial nerve except mild leftward tongue deviation when extended.