22 years old Female Japanese flight attendent presented with a 1 week history of sore throat. He state to be in bed for the last 4 days as he felt tired and lethergy.
Patient was unable to swallow solid for the last 3 days but able to drink.
He seen his GP 1 days prior to this consultation. Patient was prescribed oral amoxycillin and noticed that generalised maculopapular rashes over her body the next day.
Her initial observation are as followed:-
T37.8C PR90 BP114/78 SatO2 99%A GCS 14/15 E3 V5 M6
Cardiorespiratory and abdominal examination – NAD
Cranial nerve and peripheral nervous system – NAD
ENT examiantion revealed erythemous tonsil with white exsudate and cervical lymphadenopathy.
No meningism noted
WCC 12.4 – lymphocytosis & VBG – NAD
ECG – sinus tachycardia
EBV serology was sent
Initial impression was gladunlar fever and have amoxycillin related rashes.
Patient was observed in the observation unit following a treatment regimen of IV dexamethazone, IV fluid and antipyrexial.
A crash call went out in your observation unit 4 hours post admission, you discovered that this patient is having a self -terminated tonic clonic seizure and followed by persistent confusion. Patient remain to be tachycardia and pyrexic with a temperature of 39.2C. No meningitis noted.
A) What would be your initial impression of the cause of the seizure and its possible differential?
B) What would be your initial treatment plan?
GCS progressively drop from 14 [E4 V4 M6] to 8 [E2 V2 M4] and simultanously noted progressive bradycardia with prolonged pauses. R.S.I was preformed. CT head and lumbar punture was then carried over
CT head – NAD
L.P – WCC 70 80% Lymphocytes Glu 5 [Serum Glu 6] Protein 3
Repeat blood – WBC 20.4 U&E/LFT/Coagulation/ Ca/Mg/PO4/CXR – all Normal
EBV serology +ve
Patient subsequnetly admitted to ITU and show signs of raised ICP on day 2 of admission.
Repeat CTbrain noted diffuse cerebral oedema and anounced brain death on the evening of day 2.
C) What is the likely diagnosis of this case?