Influenza Encephalitis in a Collegiate Baseball Player

Abstract

HISTORY: A 20 year old male, NCAA Division I baseball player presents to athletic trainer with a chief complaint of a severe headache. Associated symptoms included numbness in bilateral fingertips and lips, disoriented and look tired and fatigued. Athlete could answer questions asked but could not recall details of the morning prior to presenting to the athletic trainer. He had a previous history of headaches, coughing and congestion over past few months. Previous headaches were treated with over the counter medications and sleep. Athlete also had a medical history of ADHD and surgical history of tonsillectomy and adenoidectomy 2013. PHYSICAL EXAM: No obvious deformity and no visible sites of trauma. Full strength in upper extremities bilaterally; normal sensation bilaterally except for fingertips and lips. Deterioration of mental status over the following hour and was unable to understand simple commands or reply verbally. Athlete was transported to the Emergency Department. Upon arrival, athlete became combative due to disorientation and was intubated for his safety. DIFFERENTIAL DIAGNOSIS: 1. Migraine Headache 2. Intracranial Hemorrhage 3. Meningitis TESTS & RESULTS: Complete Blood Count Test- mild elevated white blood cell count (13.4) Comprehensive Metabolic Panel- within normal limits Urine Toxicology- within normal limits CT Scan- normal MRI- normal Lumbar Puncture- elevated with white blood cell count Influenza Test- positive for influenza b FINAL/WORKING DIAGNOSIS: Influenza Encephalitis TREATMENT & OUTCOMES: • Intubated and admitted to the ICU • Hospital day #2 was extubated • Treated with Tamiflu for influenza b • Discharged to go home and follow up with athletic training staff • No residual symptoms, feeling well • Athlete successfully participated in 2015 baseball season