Report #2851383

Received Jul 27, 2025

Life-threateningHospitalizedER / ED visit

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Overview

Sex: Female
Age: 50 yrs
State: MN
Recovered: Recovered
Vaccinated: Jul 17, 2025
Onset: Jul 24, 2025
Days to onset: 7
Hospital days: 4

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
VARZOS	ZOSTER (SHINGRIX)	GLAXOSMITHKLINE BIOLOGICALS	1	3273H	IM / RA

Symptoms (39)

AgitationAlanine aminotransferase normalAnalgesic drug level therapeuticAspartate aminotransferase increasedBacterial test negativeBlood creatine phosphokinase increasedBlood culture negativeBlood lactic acid increasedBorrelia test negativeC-reactive protein increasedCSF glucose increasedCSF lymphocyte count normalCSF monocyte count negativeCSF neutrophil count increasedCSF protein increasedCSF red blood cell count positiveCSF virus no organisms observedComputerised tomogramComputerised tomogram head normalComputerised tomogram normalConfusional stateDiscomfortDrug screen negativeElectroencephalogram abnormalEndotracheal intubationFungal test negativeGlycosylated haemoglobin normalHIV test negativeHepatitis A antibody negativeHepatitis C antibody negativeLymphocyte count increasedMagnetic resonance imaging head normalMental status changesMonocyte count increasedRed blood cell sedimentation rate increasedScan with contrast normalTroponin increasedUrinary castsWhite blood cell count increased

Symptom narrative

Patient woke up middle of the night early in the AM 7/24 and couldn't get comfortable, took a Tylenol, turned the fan on then went back to sleep. Family wound her confused/altered mental status in the AM and she was very agitated and not herself. At baseline she has normal cognitive functioning and behavior so that was abnormal for her. Brought into the ED by EMS and was ultimately intubated sedated for altered mental status and airway protection. She spiked one temp here in the ED but then no more. She returned from a camping trip recently so infectious causes were in the differential for encephalopathy but her CT head, Brain MRI, LP were all negative for infection. CT CAP negative for any abnormalities. Lactate was mildly elevated. She was extubated within ~48 hours and was awake, alert, talking normally and doesn't recall anything that happened.

Current illness

None

Medical history

Obesity, GERD

Other medications

None

Allergies

Adhesive - rash

Lab data

CT head (7/24): no acute intracranial abnormality. MRI brain w/ and w/o contrast (7/24): normal. CT CAP (7/24): normal. Lactate (7/24) was 3.3 initially and then normalized. CBC/Diff (7/24): WBC 12.61, abs lymph 4.9 (slightly elevated), absolute monocytes 1.02 (barely elevated). WBC normalized the next day (9's). Sed rate 34. UA (7/24): normal other than 6-10 hyaline casts. Troponins elevated (7/24). CK (7/24) 400. LFTs (7/24) ALT and AST barely out of range (35 and 43 respectively) and normalized the next day. CRP (7/24): 9. HgbA1c 5.7 (7/24). Lumbar puncture (7/24): glucose 78, RBC <1000, nucleated cell count 2 (N-9%, L-59%, M/M-32%), protein 62. Acetaminophen, Salicylate and Urine drug screen negative (7/24). Blood cultures negative (7/24). CSF cultures negative bacteria/fungi (7/24). Meningitis/encephalitis panel negative on CSF. HIV combo negative, Hep A IgG negative, HCV Ab negative, Lyme Ab negative. Many other infectious studies pending but low suspicion given imaging and LP normal. EEG with out seizures but c/w diffuse encephalopathy.