A 66-year-old Man With Fever and Altered Mental Status: A Case Report

Federica Romano, Raffaella Radin, Paolo Ghiringhelli

DOI: https://doi.org/10.7175/cmi.v12i1.1350

Abstract

We describe the case of a 66-year-old man who was admitted to the Emergency Department with high fever, urinary incontinence, asthenia, and altered mental status characterized by drowsiness and lethargy from the previous night. The head CT scan was negative, while the chest X-ray showed a right basal reduced transparency and solitary pulmonary nodules already known and considered as expression of asbestosis. No acute neurological signs were observed by the consultant neurologist. A diagnosis of right basal pneumonia complicated by delirium was made and an empiric antibiotic therapy with ceftriaxone plus azithromycin was started. As patient’s conditions did not improve in the following 48 hours, a lumbar puncture was performed, with the microbiological isolation of L. monocytogenes. According to the indications of the infectious disease consultant, a new antibiotic regimen with ampicillin/sulbactam plus gentamicin was introduced. The chest CT scan performed as further examination revealed right pleural thickening highly suspicious for mesothelioma. The patient was discharged after 4 weeks with no neurological deficits.

Keywords

Altered Mental Status; Fever; Meningitis; Listeria monocytogenes

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