Article Text
PDF
Abstract
A woman in her 70s presented to the emergency department with fever, fluctuating cognition and headache. A detailed examination revealed neurological weakness to the lower limbs with atonia and areflexia, leading to a diagnosis of bacterial meningitis, alongside a concurrent COVID-19 infection. The patient required critical care escalation for respiratory support. After stepdown to a rehabilitation ward, she had difficulties communicating due to new aphonia, hearing loss and left third nerve palsy. The team used written communication with the patient, and with this the patient was able to signal neurological deterioration. Another neurological examination noted a different pattern of weakness to the lower limbs, along with new urinary retention, and spinal arachnoiditis was identified. After more than 10 weeks in the hospital, the patient was discharged. Throughout this case, there were multiple handovers between teams and specialties, all of which were underpinned by good communication and examination to achieve the best care.
- infectious diseases
- meningitis
- TB and other respiratory infections
- medical management
This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
https://bmj.com/coronavirus/usageStatistics from Altmetric.com
Footnotes
Twitter @EliotMBHurn
Correction notice This article has been corrected since it has been published online. The author name has been corrected from "Jijie Annie Abraham" to "Jijee Annie Abraham".
Contributors EH contributed to writing of the main body and case note analysis, including external research and formatting. He explained the concept of consent, went through the case report with the patient and obtained initial consent from the patient. After edits to the case report were made, he contacted Dr Mukherjee to provide the patient with an updated draft of the report and to sign a newly dated consent form. LD contributed to the writing of this piece through drafting and manuscript revisions as well as research for the article. The patient was under the clinical care of JAA. The patient had E. coli meningitis, which is not a common cause of meningitis in adults. She also had concomitant COVID-19 and this was something not yet reported in journals. The patient's complications, namely complete third nerve palsy, eighth nerve palsy and arachnoiditis, were all equally interesting as was her progressive improvement. For these reasons, JAA chose to pick this case for write-up. JAA has been actively involved in literature search, discussion with the radiologist, patient’s progress and editing and referencing this case presentation.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.