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English version:
My sister suddenly had convulsion and transient consciousness loss, and was admitted to hospital on January 8, 2015. Before this, she had a trip to Thailand from December 31 2014 to January 4 2015 and got bites from the mosquito and triggerfish. She felt numb in her right arm in Thailand, felt tied, and ached in the back side of the head on January 7 which is the day before she got into the hospital. Except for that, she used to be very healthy and had no family history of the related illnesses. Physical examinations on day 1: The patient’s temperature was 37.7 degrees and her skin looked normal with fish bite scars on the left ankle. There was no marked swelling of the lymph nodes and physical examinations were all normal. She showed debility, indifference, and soft neck, but she could answer regular questions pretty well. She had no symptom and sign of meningeal irritations. Her muscle strength, muscle tone, and tendon reflexes were all normal. Examinations: 1, X - ray chest film, CT, and MRI were all normal. 2, EEG: temporal epileptiform discharged. 3, laboratory examinations: 3.1 Regular: urinalysis,complete blood count, and blood culture were all normal. 3.2 biochemical: liver and kidney function were normal; electrolytic (-); CK 297U/L (normal 30-135) 3.3 infection and related indexes: HIV/TP (-); ESR/CRP/ASO/PCT were normal; Malaria smear (-);HBsAg (-); Japanese encephalitis antibody in cerebrospinal fluid and blood(-), genetic tests for the throat swab enterovirus were normal. 3.4 Immunology: ANCA 3.4, a full set of ENA, ANA were normal; serum and follicular fluid immunoglobulin (IgG, IgA, IgM) and complement (C3, C4) (-) 3.5 On Jan 12th, CSFroutine, biochemical, acid fast stain Chinese ink dyeing glass slice, and bacterial culture were normal. However, the cerebrospinal fluid nucleated cells were 25 (5 is normal) and lymphocyte percentage (LYM %) was 78 (20-40is normal). 3.6 Tumor: five tumor marker tests ( -). 3.7 Metabolic: five thyroid function tests (-), thyroglobulin antibody 7.50IU/ml (0-4), thyroidperoxidase antibody(TPOAb) 10IU/ml 130. Diagnosis: fever, epilepsy,mental behavior disorder of unknown agents Treatments and the symptoms: On Jan 8th, the patient began the antiepileptic treatments. She had low fever of 37.6 degree and the doctor gave her sodium valproate static pump treatment and phenobarbital injection. In the afternoon on Jan 9th, the patient felt better and could eat by herself. In the afternoon on Jan 10th, the patient’s temperature gradually rose to 38.5 degrees. After 2-3 days, her temperature dropped and remained 37.5 degrees. 5-6 days later her temperature rose again to 38.5 degrees. The patient appeared to be in a trance with mental disorder symptoms. She began to talk rubbish and could not answer the questions to the point. In the evening on Jan 11th, the doctor began to suspect that the patient got viral encephalitis,then the doctor provided her acyclovir 0.5 Q8H 0.5 q8h iv drop treatment and gave her sodium valproate for oral intake. On Jan 13th, the department of infection advised her to take minocycline hydrochloride 100mg q12hPo. From Jan 14th to 16th,the patient had clear thinking in the Morning while was in a trance in the afternoon. On Jan 17th, the patient had better consciousness recovery the whole day. From Jan 18th to 19th,the patient was pretty normal in the morning. On Jan 19th, the patient appeared to be stubborn. From Jan 20th to Jan 22nd, the patient showed mental disorder symptoms gradually. She talked rubbish and could not answer the questions to the point. The symptoms gradually became more and more severe. On Jan 22nd, the patient stopped taking minocycline hydrochloride.
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发表于 2015-1-25 23:48:34
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