Abstract
A 74-year-old female nursing home resident with Alzheimer disease was admitted to the hospital with a 5-month history of aggressive behavior, including physically striking other nursing home residents. She had been treated with quetiapine with mild improvement; however, she became tremulous while receiving this medication and so was switched to 0.125 mg/d of risperidone orally. Unfortunately, the patient continued to act aggressively and was brought to the emergency department, where she was unable to follow commands or answer questions appropriately. Laboratory blood tests revealed an elevated serum creatinine level of 1.2 mg/dL (0.6-1.1 mg/dL), compared with a baseline of 0.8 mg/dL. Urine studies showed the presence of gram-negative bacilli and 10 to 20 white blood cells per high-power field, indicating a possible urinary tract infection (UTI). Results for all other diagnostic tests were unremarkable. The patient was treated empirically with a 10-day course of sulfamethoxazole-trimethoprim (SMX-TMP) for a presumed UTI and admitted to the psychiatry unit for behavioral dyscontrol.
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