Neurological complications in psittacosis: a case report and literature review

Abstract

Case Report A 51-year-old crab fisherman was admitted with a 3-day history of testicular pain, arthralgia, headache, fever and sweats. There was no relevant medical history but 12 days prior to the onset of his symptoms, he had returned from a 2 week holiday in Kenya. The only abnormalities on examination were a low grade pyrexia (t = 37.5”C) and mild right upper quadrant tenderness. On initial investigation, blood count, renal and hepatic function, chest radiograph, abdominal ultrasound and malaria films were normal. C reactive protein was grossly elevated (385 mg 1 ‘, n< 10). The patient received oral quinine to treat presumed malaria, although subsequent malaria films remained negative. His symptoms and fever persisted. On the seventh day of admission, tetracyclin was added empirically to treat a possible Rickettsial illness, although without microbiological evidence to support this diagnosis. During the subsequent 3 days, his headache, pyrexia and abdominal tenderness resolved, but a productive cough with pleuritic chest pain developed. A chest X-ray on Day 10 demonstrated patchy consolidation in the right upper lobe, but sputum culture was negative and the white cell count remained normal. Tetracycline was discontinued and replaced with amoxycillin. On Day 14, the patient reported recurrence of headache, but was otherwise clinically unchanged. Over the following 48 h, his headache worsened with the development of confusion, left-sided dysaes-