A 57-Year-Old Woman Present with Acute Delirium and Fever

Abstract

<p>燒合併急性譫妄（Acute delirium），臨床上常被認為感染導致。本個案57歲女性，三天前因發燒、意識混亂與腹瀉，初步臆測診斷為細菌性腸炎造成譫妄，經糞便、血液細菌培養、腦部電腦斷層、腦脊髓液檢查、腦波與皮質酮（cortisol）檢驗均正常，抗生素治療下仍高燒不退、腹瀉、心搏過速，急劇意識昏迷併呼吸衰竭及全身抽搐。回顧此個案罹患甲狀腺機能亢進又擅自停藥，近期使用Xenetix碘顯影劑，當同時出現高燒、意識改變、腸胃肝膽障礙與心搏過速，按照甲狀腺風暴（Thyroid storm）診斷評分100分應高度懷疑甲狀腺風暴，盡快給予ß交感神經阻斷劑、降低甲狀腺激素合成、糖皮質類固醇、含碘製劑治療，經治療後個案意識與精神症狀獲得改善並順利出院。本篇教學著重如何快速鑑別診斷並牢記甲狀腺風暴評分項目與相關誘發因子，進而早期診斷與積極治療，可降低死亡率及多重器官衰竭，達到個案回歸日後自我照護能力。</p> <p> </p><p>Acute delirium is usually caused by infection, clinically. The case in this study is a 57-year-old woman with fever, confusion, and diarrhea for 3 days. The initial diagnosis was delirium caused by bacterial enteritis. Examinations of feces, blood bacteria culture, computed tomography scan, cerebrospinal flu-id, electroencephalography, and cortisol were all normal. However, high fever, diarrhea, tachycardia, acute unconsciousness with respiratory failure, and general convulsions persisted despite antibiotic treatment was applied. After recalling medical history the patient was suffered from hyperthyroidism and discontinued medication without permission. Furthermore, a Xenetix iodine contrast agent was re-cently administered while symptoms such as high fever, altered consciousness, gastrointestinal hepa-tobiliary disturbance, and tachycardia occurred simultaneously. Therefore, the possibility of a thyroid storm became apparent after applying the thyroid storm 100-point diagnosis scale evaluation. As such, ß sympathetic blockers, reduction of thyroid hormone synthesis, glucocorticoids, and preparations con-taining iodine were administered immediately. After treatments, the consciousness and mental symp-toms of the patient were improved and then successfully discharged. This case suggests that a rapid differential diagnosis by remembering the thyroid storm grading scale as well as relevant predisposing factors shell be considered in early diagnosis. Furthermore, proactive treatments could be utilized to reduce mortality rate and the possibility of multiple organ failure, thereby allowing patients to recover self-care ability in the future.</p> <p> </p>