A Case Report On Sepsis With Brain Stem Encephalitis In A Patient With Quadriplegia

Abstract

Introduction : Every year, 1 in 10,000 people develop encephalitis, which frequently has grave neurologic repercussions. Identifying the cause and establishing the prognosis are difficult aspects of managing encephalitis patients. Presentation of case : A 20-year- Female came to a rural tertiary care hospital with the chief complaint of Fever, abnormal jerky movements of limbs and body, vomiting, and loose stools last 3 days. The patient was apparently alright 3 days ago when she developed a fever that was insidious in onset and progressive in nature not associated with chills or rigors, remitting with antipyretic medication. She also experienced abnormal jerky movements of all four limbs along with stiffness, associated with jaw lock, tongue bite, and frothing from the mouth, there was post ictal drowsiness along with it, with no involuntary bowels or bladder evacuation. History of loose stools 2 episodes, watery in nature, non-blood or mucus stained. She also complained of 2 episodes of vomiting which was projectile in nature and associated with nausea containing food particles and water. The patient had a history of 70 days PNC and delivered normally vaginally full-term delivery, without any complications. Management : Patient was intubated and was taken on a mechanical ventilator on volume control mode. Started treatment Inj meropenem 500mg iv for 7 days, INJ clindamycin 600mg iv for 5 days, injection vancomycin 500mg iv for 3 days, injection linezolid 600mg iv for 5 days, injection acyclovir 500mg iv for 14 days, injection doxy 100mg iv bd for days, injection ciprofloxacin 400mg iv for 7 days, injection colistin for 14 days, injection MPs 250mg IV od for days, injection Emset 4mg iv /sos, injection lomoh 0.6ml/od for 31 days, injection mannitol 150mg iv for 14 days, injection pan 40mg iv for 7 days, injection Emset 4mg iv for 5 days, injection levipil 500mg iv for 5 days. oral suctioning 2 hourly, physiotherapy. The patient’s general condition was stable. Conclusion : BE is a disease that advances quickly and has incapacitating effects. Significant gains were visible after receiving extensive supportive and rehabilitative therapy.