High-grade Fever Research Articles

Case Report on Dengue Induced Myocarditis

Background: Due to the wide range of clinical symptoms, myocarditis is a difficult diagnosis. Myocarditis can range from mild to severe, resulting in congestive heart failure, arrhythmias, cardiogenic shock, and death. It predicts morbidity and mortality in dengue-infected patients. Case presentation: we presented a 12year old child who came to the pediatric department brought by mother with a chief complaint of high grade Fever insidious onset since 5 days, Episodes of vomiting non projectiles, non-foul smelling contain food particles since 5 days and pain in abdomen more in right hypochondrial region, non-radiating. He has a no previous history of hospitalization.During a physical examination Head to toe examination reveals few abnormalities; the kid is slim and skinny, with a dreary appearance. He is frail and uncooperative.. Though it found that he develop acute myocarditisand the patient treated with antibiotic, antacid , antipyretic, antidiuretic as well as antiemetic.Conclusion: Dengue-induced myocarditis is a serious condition. Through direct virus activity on cardiomyocytes, dengue virus can induce unusual symptoms such as acute myocarditis, cardiogenic shock, and death. Physicians caring for dengue patients should be aware of this potential result. Elevated cTn-I predicts length of stay and in-hospital death in dengue-infected patients. Diabetes, hypertension, low blood bicarbonate, high serum creatinine, and any echocardiographic abnormalities were all linked to poor outcomes in dengue-infected people.

Life threatening macrophage activation syndrome as the initial presentation of systemic lupus erythematosus: A case report and review of the literature

BackgroundMacrophage activation syndrome (MAS) is characterized by activation of hemophagocytic cells and is a very rare initial manifestation of systemic lupus erythematosus (SLE). Aim of the workTo describe the features of a challenging case of SLE initially presented with MAS. Case reportA previously healthy 20-year-old female was referred to the Rheumatology clinic with a 25-days’ history of persistent fever, general fatigue, and significant weight loss. Clinical examination revealed a high-grade fever (41 °C), significant hair loss and general malaise. Laboratory investigations revealed leucopenia (1.5 × 109/L), neutropenia (0.7 × 109/L), lymphopenia (0.6 × 109/L), normocytic normochromic anemia (9 g/dL), thrombocytopenia (95 × 109/L), elevated liver enzymes, hyperbilirubinemia (2.6 mg/dl); hypertriglyceridemia (306 mg/dL), hyperferritinemia (16000 ng/mL), elevated D-Dimer (4.7 mg/L), elevated lactate dehydrogenase (1379 U/L) and direct and indirect Coombs' tests were positive. Erythrocyte sedimentation rate was 28 mm/1st h. Immunological screening was positive for antinuclear antibody (ANA) and anti-double stranded deoxyribonucleic acid (anti-dsDNA). Serum C3 and C4 complement factors were low and C reactive protein was negative. Soluble CD25 was elevated (9800 pg/ml). Bone marrow biopsy showed hypocellular bone marrow with normal megakaryocytes and erythroid series with evidence of hemophagocytosis. A diagnosis of SLE initially presented with MAS was made. The patient received intravenous methylprednisolone for 5 consecutive days followed by prednisolone and cyclosporine A and intravenous immunoglobulin. The condition deteriorated with progressive coagulopathy, thrombocytopenia and hyperferritinemia. Subsequently, the conscious level of the patient deteriorated, multiorgan failure developed and the patient died. ConclusionMAS is a serious condition that may be the first presentation of SLE.

A CLINICAL CASE REPORT ON XANTHOGRANULOMATOUS PYELONEPHRITIS WITH STAGHORN CALCULUS

The uncommon condition known as xanthogranulomatous pyelonephritis (XGP) is characterized by renal parenchymal loss and is replaced by solid sheets of lipid-rich macrophages. Most cases affect women in their mid-twenties. A histopathologic analysis provides a precise diagnosis. The only effective treatment is a whole or partial nephrectomy. Nephrostomy is our suggested procedure because it makes microbiological diagnosis and operation easier (nephrectomy). Here we discussed a case of xanthogranulomatous pyelonephritis with staghorn calculus and its surgical management. The present complaints and investigation: A 38-year-old woman who had been experiencing right flank pain for two to three months and a high-grade fever registered with the urology department. She has a history of anemia. Now she has come here for further treatment. The doctor made the diagnosis of xanthogranulomatous pyelonephritis with staghorn calculus following a physical examination and further testing like blood and urine analysis. Inj. Ceftraxone 1 gm BD, Tab. Pantop 40 Mg OD, Inj. Emset 4 Mg SOS, Inj. Tramadol TDS, Calcium, iron, and folic acid supplements were given.conclusion: Her general condition was good and all treatment was completed.

GeneXpert Ultra- a New Diagnostic Era for Childhood Tuberculosis

Introduction: Tuberculosis (TB) is a serious public health problem and a significant diagnostic and therapeutic challenge worldwide. Molecular diagnostic techniques are crucial in the World Health Organization’s new tubercular control strategy. Objective: The study aims to investigate the efficacy of GeneXpert Ultra in the diagnosis of childhood tuberculosis. Methods: A prospective cross-sectional study was carried out in the pediatric pulmonology ward and general pediatric ward of the Institute of Child and Mother Health (ICMH), Matuail, Dhaka. Child ages ranging from two months to fifteen years who were admitted to the pediatric pulmonology ward and general pediatric ward of ICMH during the period of December 2020 to November 2021 with a history of fever, cough, chest pain, evening rise of temperature, night sweats, weight loss were included in this study. Results: Among the study population (N=99), almost all the patients (91, 91.2%) had cough, thirty-six patients (36, 36.3%) had cough for 2 weeks, and about half of the patients (49, 49.5%) had a productive cough, ninety patients (90, 90.9%) had fever, around one-fifth of the patients, had a fever more than two weeks. About half of the patients (47, 47.5%) had a high-grade intermittent fever. Evening rise of temperature was seen in around one-fourth of the patients (24, 24.2%). MT test was positive for two patients (2, 2.0%) and doubtful for two patients (2, 2.0%)., Seventeen patients (17, 17.1%) specimens were collected from induced sputum, around three-fifths of the patients’ (70, 70.7%) specimens were collected from gastric aspirate, eighty-two patients (82, 82.8%) specimens were collected from the stool and one patient’s specimen (1, 1.0%)was collected from pus produced in BCG vaccine site. GeneXpert ultra was detected in thirteen patients (13, 13.1%) and was trace detected in six patients (6, 6.0%). Of the 13 patients, 7 patients (7, 53.8%) were diagnosed with pulmonary TB, two patients (2, 15.4%) were .....

A RARE CASE OF PROTRACTED ANAPHYLAXIS CAUSED BY ACETAMINOPHEN

<h3>Introduction</h3> Acetaminophen is a rare but recognized etiology of anaphylaxis. We present an unusual case of protracted anaphylaxis requiring intensive care unit (ICU) monitoring following intravenous (IV) acetaminophen. <h3>Case Description</h3> A 49-year-old female with a history of ovarian cancer presented to the emergency department with pruritic urticarial rash, fevers, tachycardia, and relative hypotension. A sepsis workup was initiated. Hemodynamics improved with broad-spectrum antibiotics and fluids. Due to symptomatic high-grade fevers, IV acetaminophen was administered. Her rash, tachycardia, and relative hypotension worsened one hour following infusion. Despite resuscitation with diphenhydramine and fluids, she remained tachycardic and febrile, prompting treatment for suspected anaphylaxis with intramuscular epinephrine, corticosteroids, and additional diphenhydramine. Her rash and hemodynamics improved moderately. She was subsequently started on norepinephrine and transferred to the medical ICU, where she had two days of persistent tachycardia and fluctuating urticarial rash responsive to antihistamines. Infectious workup was unrevealing. She later revealed a prior history of urticaria following home oral acetaminophen. Tryptase drawn one hour after decompensation was elevated to 23.8 mcg/L (baseline 3.2 mcg/L). The diagnosis was made of IgE-mediated reaction to acetaminophen causing protracted anaphylaxis. <h3>Discussion</h3> Anaphylaxis secondary to acetaminophen is an uncommon but recognized phenomenon. An initial differential included pseudoallergic reaction, given acetaminophen can be a weak cyclooxygenase-1 inhibitor causing direct mast cell activation and urticaria; however, this does not classically cause hypotension. Overall, this presentation may represent a mixed picture of sepsis of unclear etiology with superimposed IgE-mediated reaction. It is important to recognize anaphylaxis can co-exist with sepsis and manifest with overlapping symptoms.

Brucellosis in older person: a case report from Qatar

Background Brucellosis is a multisystem disease with a broad spectrum of non-specific symptoms that generally occur within three weeks but sometimes up to 3 months after inoculation. Human brucellosis is quite uncommon in Elderly in Qatar. Case report This report describes a case of Brucellosis in acute geriatric unit under Rumailah Hospital in Qatar. The patient was an 81-year-old Qatari Gentle man, functionally able to walk with minimal assistance and had mild cognitive impairment who presented with high-grade fever with chills, anorexia, low back pain and arthralgia for 10 days. The above complaints occurred often for 1 month and had fever intermittently. Lab investigations revealed as high CRP 117 mg/l, low Hb 9.1 g/dl and mild elevation in ALP (151 µ/l) with normal leukocyte and platelet count. His blood culture positive for Brucella melitensis with high brucella Antibody titter 1:1280. The diagnosis made as Brucellosis. Discussion The clinical manifestations of Brucellosis are fever, night sweating, chills, arthralgia and loss of appetite. It seems pyrexia of unknown origin without other symptoms is most common presentation of Brucellosis in old age. The confirmation of Brucellosis made with serological tests, with significantly high titer, in the presence or absence of blood culture. Brucella antibody titers (≥1:160) are suggestive of active infection. Anemia and raised CRP and liver enzymes were the most prominent laboratory abnormalities in our patients. Previous study from Qatar reported that 41.7% had a history of raw milk consumption and 12.5% had a history of animal contact. The objectives of Brucellosis treatment include the prevention of complications and relapse. Conclusion Our case presented with classical symptoms and received appropriate treatment on time. However, atypical clinical presentation and lack of specific history taking can delay diagnosis and treatment; it leads to serious clinical disease progression with increased complications. From this case study, we would contribute to optimal assessment and to keep differential diagnosis for unknown cause of fever can be Brucellosis in geriatric population.

An interesting case of COVID induced multi system inflammatory syndrome

COVID-19 derives from infection with Coronavirus [severe acute respiratory syndrome (SARS)-CoV-2] is associated with high morbidity and mortality. These hazardous impacts are due to the release of a storm of pro-inflammatory cytokines and thrombogenic agents. Increasing evidences about multi organ involvement in COVID infection have started pouring in, where patients who either recovered from or had mild symptoms after COVID-19, exhibit diffuse multi organ related symptoms. We describe a case of a 23-year-old male who presented to emergency room with intermittent high-grade fever, sudden onset of breathlessness, giddiness and weakness. His COVID RTPCR was negative. He was unvaccinated but his covid antibodies were increased multifold. Further examination revealed active multi organ involvement which suggestive for multisystem inflammatory syndrome (MIS). With appropriate diagnosis and treatment patient improved clinically over a course of 3 weeks and discharged and is under regular follow up.

Postpartum Hypernatremia with Extrapontine Rhabdomyelinolysis: A Case Report.

Hypernatremia (serum sodium>160 meq/L) present with diverse neurological manifestations, ranging from flaccid paralysis to impaired cognition, encephalopathy, and even deep coma. Osmotic demyelination refers to changes in brain cells because of an acute change in plasma osmolality. It is further divided into two types, i.e., central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM). Patients with EPM, besides spasticity, may also present with other movement disorders such as catatonia, parkinsonism, and dystonia. We present a case of a postpartum woman bought to the emergency department by her relatives in an unconscious state. In view of poor sensorium (Glasgow coma scale < 7), she was intubated and received mechanical ventilatory support. On admission, computed tomography ofthebrain was normal, and the patient was transferred to the intensive care unit (ICU) for further management. The preliminary work-up in the ICU showed hypernatremia (serum sodium of 182 mEq/L) with hyper-osmolality (359 mOsm/kgH2O). She was managed as per the ICU protocol for hypernatremia. During her ICU stay, her sensorium improved, but she developed flaccid paralysis and was quadriplegic. Thus, a tracheostomy was performed, and she was weaned from the ventilator. After ventilator weaning, she was transferred to the ward for further rehabilitation. During rehabilitation, the patient was able to sit and takefoodorally.To date, only a few cases are reported in postpartum women with acute severe hypernatremia caused by high-grade fever and loss of body fluids leading to extra-pontine demyelination and flaccid paralysis. This case highlightsthat prompt recognition and appropriate intervention can improve the outcomes in these patients.

Drug Induced Neuroleptic Malignant Syndrome: A Case Report

Neuroleptic malignant syndrome (NMS) causes fever, muscle rigidity, and impaired mental status. Drugs that influence central dopaminergic neurotransmission and almost all neuroleptics, including newer atypical antipsychotics, are also associated with it. While uncommon, NMS remains a critical differential diagnosis for patients with fever and mental status changes due to the requirement for prompt resuscitation to prevent morbidity and mortality. We present a case of a 21-year-old man with schizophrenia who attended the emergency room with generalized muscle rigidity, high-grade fever, and disturbed mental status for 12 days. His serum creatine phosphokinase was elevated (CPK). The computed tomography (CT) of the brain was normal, and the CSF was clear and cell-free. The patient was given muscle relaxants, dopamine agonists, and biperiden. After three days, rigidity, fever, and consciousness improved. A few cases of antipsychotic-induced NMS have been reported. Healthcare professionals should be aware of this fatal side effect.

P-055 LAPAROSCOPIC EXPLANTATION OF GROIN MESH WITH STAPLED EXCISION OF COLO CUTANEOUS FISTULA

Abstract Aim Groin mesh explantation is a challenging situation and a multidisciplinary approach at index explantation surgery can avoid a long term catastrophic situation for the patient . Material &amp; Method The history of the patient started a decade back with bilateral laparoscopic TAPP, following which he had swelling in both groin area with high grade fever . He was advised open bilateral groin exploration and explant of the mesh. Post procedure he was kept on antibiotics for few weeks and he was asymptomatic, he developed swelling again and started on anti mycobacterial treatment He presented four years with foul smelling discharge from the suprapubic area . CT Scan with sinogram revealed a communication with sigmoid colon and tacker from index surgery We planned laparoscopic approach, stapled excision of sigmoid-cutaneous fistula was performed . Removal of residual mesh and tacker from index under fluoroscopy guidance with skin tract excision .Intra op flexible sigmoidoscopy revealed no lumen compromise . Histopathology showed granulomatous inflammation for which he was started on atypical mycobacterial treatment for 9 months .He remains uneventful after 2 years of surgery . Conclusion Mesh infection should be avoided at index surgery with utmost care to aseptic precautions. Mesh explantation should be a part of multidisciplinary approach, radiology and colonoscopy were key investigations in this case . One should plan for a complete removal of mesh and tacker/s at index explantation surgery for safe long term outcomes .

Case Report on Kawasaki Disease with Rectal Prolapse

Background: Mucocutaneous lymph node syndrome and infantile polyarthritis nodes are other names for Kawasaki illness, which is characterized by inflammation of the walls of various blood vessels in the body. It is particularly common among children and adolescents. Case presentation: A 6-year-old male child was brought by his parent to the pediatric unit after suffering from high-grade intermittent fevers of up to 102°F for three days, mild dehydration, tachycardia, rhinorrhea, cough, oropharyngeal changes, and oral thrush. He has a history of the previous hospitalization for a mild case of rectal prolapse which was pushed into place manually. On physical examination, he was agitated, febrile, and had a body temperature of 102°F. He also had mild swelling in the lymph node, no pallor but some dehydration, tachycardia (130 bpm), a respiratory rate of 35 breaths per minute, redness of the tongue, redness of the sole, a skin rash, and edematous lips. Later he was treated with antiplatelets, antibiotics, and intravenous fluids. Conclusion: Kawasaki disease (KD), an unusual kind of systemic inflammation, is most frequently found in children below the age of five. Due to the maternal antibodies' protective qualities, Kawasaki disease is rarely diagnosed in infants under the age of four months. There are ten to twenty occurrences per 100,000 children under five. The most well-known cause of acquired cardiovascular disease in newborns and young children is Kawasaki disease. If recognized and treated promptly, kids feel better in a few days and have a low risk of developing long-term heart issues.

Two Sisters were Diagnosed with Childhood Systemic Lupus Erythematous

We are herein reporting two female siblings with childhood-onset Systemic Lupus Erythematosus (SLE). The children were diagnosed as having SLE in reverse birth order at ages 2 and 6 years. Younger sister's initial symptoms were serositis, proteinuria, and hemolytic anemia with laboratory findings of hypocomplementemia and positive ANA/anti-dsDNA antibody. After 18 months, the older sister presented with high-grade fever, arthralgia proteinuria, oral mucous ulcer, butterfly rash, and positive ANA/anti-dsDNA antibody.

Hypohidrotic Ectodermal Dysplasia: a rare inherited multisystem disorder

Hypohidrotic ectodermal dysplasia (HED), also known as Christ-Siemens-Touraine syndrome, is a rare X-linked genetic disorder characterized by the faulty development of the ectodermal structures, resulting in most notably anhydrosis/ hypohidrosis, hypotrichosis and hypodontia. Here, we report clinical presentation of a HED case. A female child aged 8 years was brought with complaints of high grade fever along with upper respiratory tract illness symptoms. She also had recurrent episodes of unexplained hyperpyrexia and thirst. Physical examination revealed characteristic appearance which aided in arriving at a diagnosis. Diagnosing this disorder in early life prevents mortality which is high especially during neonatal period. Therefore, it is essential for the treating clinician to have basic knowledge on the clinical presentations as well as complications of this specific genetic disease so that it is not missed. It is rare to see a classical case of hypohidrotic ectodermal dysplasia in female children with typical phenotypic features hence, this case report is presented.

SUCCESSFUL TREATMENT OF SEVERE ADENOVIRUS PNEUMONIA WITH CIDOFOVIR IN A IMMUNOCOMPETENT PATIENT

SUCCESSFUL TREATMENT OF SEVERE ADENOVIRUS PNEUMONIA WITH CIDOFOVIR IN A IMMUNOCOMPETENT PATIENT

BABESIA MICROTI INFECTION WITH LOW-GRADE PARASITEMIA CAUSING ARDS IN AN IMMUNOCOMPETENT PATIENT

BABESIA MICROTI INFECTION WITH LOW-GRADE PARASITEMIA CAUSING ARDS IN AN IMMUNOCOMPETENT PATIENT

A CASE REPORT OF WERNICKE'S ENCEPHALOPATHY IN A PATIENT WITH SEPSIS

Thiamine (vitamin B1) is an essential water soluble vitamin that plays an important role in energy metabolism. Thiamine deciency can cause various clinical manifestations ranging from mild neurological and psychiatric symptoms (confusion, reduced memory, and sleep disturbances) to fatal consequences like Wernicke's encephalopathy, ataxia, congestive heart failure, muscle atrophy, and even death primarily in alcoholics. Concurrent illnesses and overlapping signs and symptoms with other disorders can further complicate this. Many patients with sepsis, critical illness develop altered mental states, variously described as disorientation, confusion, delirium and encephalopathy without obvious explanation. We report a case of Wernicke's encephalopathy in sepsis with acute kidney injury in a 26 year old male who is chronic alcoholic without other comorbidities who presented with high grade fever, vomiting for 3 days, difculty in walking and altered sensorium for 1 day. Leucocyte count was elevated on hemogram, renal function tests were abnormal suggesting acute kidney injury, ESR and CRP were raised. MRI ndings were suggestive of Wernicke's encephalopathy and there was signicant improvement in symptoms after thiamine supplementation.

MATERNAL AND FETAL OUTCOMES IN FEVER COMPLICATING PREGNANCY BEYOND 32 WEEKS OF GESTATION

To identify the relationship between the fever complicating pregnancy beyond 32 weeks of gestation and its maternal and fetal outcomes. A semi structured proforma entailing a detailed history and examination were done among 100 antepartum mothers with fever for ≥2 days, beyond 32 weeks of gestation. Pneumonia was the major causation of fever (21%). The majority of the participants (72%) had a fever duration of less than 5 days and experienced high grade fever(82%). High grade fever was associated with urinary tract infection and pneumonia was associated with premature rupture of membranes. Fever of less than 5 days was associated with premature rupture of membranes and NICU admissions.

S379 Successful Use of a Novel Through-the Scope Suturing Device to Close a Duodenal Fistula Caused by Foreign Body Penetration

Introduction: Endoscopic treatments have become vital in managing transmural gastrointestinal defects both as a first-line and rescue treatment. The latest advances in interventional endoscopy have made a paradigm shift in managing these defects from surgery to minimally invasive endoscopic procedures. We present a unique presentation of a perforation caused by foreign body ingestion (FBI), leading to a chronic duodenal fistula that was treated with a novel through the scope suturing device (X-Tack Endoscopic HeliX Tacking System). Case Description/Methods: A 28-year-old male presented with a 4-week history of intermittent right upper quadrant abdominal pain associated with high-grade fevers. He had a past medical history and multiple episodes of FBI in the past.CT scan of the abdomen and pelvis revealed a large (14.2cm X 10.7cm) multiloculated liver abscess(Figure A). It also showed an impacted foreign body in the duodenum (Figure B) and multiple foreign bodies in the small intestine (Figure C). An EGD was performed, which revealed a spork in the second part of the duodenum (Figure D), which was removed using a snare(Figure E). A chronic-appearing fistulous tract was visualized at the duodenal sweep(Figure F). We decided to close the defect with a novel through-the-scope suturing device. Four HeliX Tacks were placed approximating the defect, and the suture was cinched with the endoscope cinching device. After deployment of the sutures, there appeared to be a residual opening; a second X-Tack with four HeliX Tacks was placed, but unfortunately, the suture broke. Finally, the third set of Helix Tack was placed, approximating the residual defect. After deployment, the fistulous tract appeared to be closed (Figure G). A follow-up CT scan with contrast revealed no residual duodenal leakage, and the patient improved clinically. Discussion: Our case exhibits a rare presentation of chronic contained duodenal perforation successfully treated with the help of a through-the-scope suturing device. This novel technique has several advantages over the traditional through-the-scope (TTS) and over-the-scope clips (OTS). It allows a suture-based deep submucosal/intramuscular fixation through a standard scope. This technique is superior for the closure of large mucosal defects as compared to traditional TTS clips. In addition, this device has improved accuracy and simplicity without the need for endoscope withdrawal for device loading. It is less invasive than surgery and more appropriate for clinically stable patients. https://tinyurl.com/ACGAbstractS379Figure 1.: (A) Liver Abscess in the Right Lobe of the Liver (B) Curved Metallic Body in 2nd and 3rd part of Duodenum (C) Small metallic bodies in the small intestine (D) Metallic Spork In the duodenum (E) Removal of Spork with a snare Image (F) Chronic Fistulous Tract in Duodenum (G) Endoscopic Closure of the Fistulous Tract

FREQUENCY AND ANTIMICROBIAL RESISTANCE PROFILE OF SALMONELLA TYPHI ISOLATED FROM DISTRICT BUNER

Objective: The objective of this study was to investigate the frequency and drug resistance of Salmonella typhi in district Buner, Khyber Pakhtunkhwa. Methodology: This cross-section study was conducted at District Head Quarter Hospital Buner and private diagnostic centers from Jan 2020 to May 2021. A total of 460 blood samples were collected from OPD patients reported with signs and symptoms of Typhoid fever. Samples were cultured on blood and MacConkey agar and incubated at 37? for 24 hours. Bacterial identification was done on colony morphology, gram staining, and polyvalent antisera for strain identification. Finally, antibiotic susceptibility testing was done for the isolated bacteria. All commonly prescribed first-line and second-option antibiotics were tested on Mueller Hinton agar by Kirby Bauer disk diffusion method following CLSI guidelines 2020. Result: A total of 240 out of 460 samples showed bacterial growth where Salmonella typhi was found in 98 (40.8%) cases. Among them, 28(28.6%) were reported as MDR while 1 (17.4%) were XDR. Out of the XDR, 4 strains were found resistant to Vancomycin and clarithromycin as well. The isolated S. typhi was 100% sensitive to Meropenem, and Azithromycin, however showed 100% resistance to Aztreonam, Ampicillin, and Cotrimoxazole. Prevalence of S. typhi was more (50%) in females while resistance was reported more in age group 20-40 years. Conclusion: The frequency of Salmonella typhi at district Buner was 41% in patients reported with high-grade fever where 28% of the strains reported were multidrug resistant. Some extended spectrum drug-resistant S. typhi and Vancomycin and Clarithromycin resistant strains were also reported which is alarming. Meropenem, and Azithromycin were the only drugs effective against most of the strains. However, resistance to these drugs may develop soon if we do not stop the empirical excessive use of antibiotics. Keywords: Multidrug-resistant, Salmonella typhi, Typhoid fever, Extended spectrum drug-resistant

Anti-NMDA Receptor Encephalitis: A Rare but Important Auto-Immune Cause of Encephalitis

Abstract: A previously healthy 30-year old lady presented with 1-day history of high grade fever and drowsiness. Five days prior to presentation, she developed insomnia and visual hallucinations of seeing unknown faces. Three days prior to presentation, she suffered from 5 episodes of generalized tonic colonic fits. On admission, she had a temperature of 102oF and GCS of 10/15 with no signs of meningeal irritation, no focal neurological deficit, normal deep tendon reflexes and down-going plantar reflex bilaterally. Her brain MRI scan showed mild hyper-intense signals in right cerebellum. Her CSF was tested for Anti-NMDA receptor antibodies which were positive. She was diagnosed as having Anti-NMDA Receptor Encephalitis and started on immediate Plasma Exchange with drastic improvement.