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- David Pavlik, MD*
- Allyson Richards, MD*
- Walter Dehority, MD*
- *University of New Mexico, Albuquerque, NM
AUTHOR DISCLOSURE
Drs Pavlik, Richard, and Dehority have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Presentation
A 14-year-old fully immunized girl residing in southern New Mexico is hospitalized with a 6-week history of fever, headache, and emesis. This is her third hospitalization for the same symptoms.
She was first hospitalized at the local hospital 2 weeks into her clinical course, where her cerebrospinal fluid (CSF) and blood were sterile, and she was discharged with persistent symptoms and a diagnosis of a viral infection.
She was readmitted 10 days later to a different outside hospital. At that time, a lumbar puncture revealed a CSF white blood cell (WBC) count of 240/μL (0.24×109/L) (70% neutrophils, 30% lymphocytes) with no red blood cells, a protein level of 0.15 g/dL (1.5 g/L), and a glucose level of 17 mg/dL (0.9 mmol/L). Bacterial cultures of the CSF were sterile. Herpes simplex virus and enterovirus polymerase chain reactions from the CSF were also negative. Results of the serologic test for human immunodeficiency virus were nonreactive. An interferon-γ release assay for Mycobacterium tuberculosis infection was negative, and a purified protein derivative demonstrated 0 mm of induration (further skin testing to investigate delayed hypersensitivity was not pursued). She was treated for an unspecified infection of the central nervous system (CNS) with ceftriaxone and acyclovir. She was discharged with persistent symptoms after completing the anti-infective course.
Five days after hospital discharge, she presents to an …
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