Diagnostic pitfalls in a young Romanian ranger with an acute psychotic episode

Elöd Ernö Nagy,1,2 Attila Rácz,3 Edit Urbán,4 Gabriella Terhes,4 Timea Berki,5 Emöke Horváth,6 Anca M Georgescu,7 Iringó E Zaharia-Kézdi71Department of Pharmaceutical Biochemistry, University of Medicine and Pharmacy o...

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Autores principales:	Nagy EE, Rácz A, Urbán E, Terhes G, Berki T, Horváth E, Georgescu AM, Zaharia-Kézdi IE
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Borrelia burgdorferi neuroborreliosis neuropsychiatric symptoms encephalitis anti-NMDAR Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/40559a18e6784a06960c8c01c76de575
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spelling	oai:doaj.org-article:40559a18e6784a06960c8c01c76de5752021-12-02T02:20:29ZDiagnostic pitfalls in a young Romanian ranger with an acute psychotic episode1178-2021https://doaj.org/article/40559a18e6784a06960c8c01c76de5752016-05-01T00:00:00Zhttps://www.dovepress.com/diagnostic-pitfalls-in-a-young-romanian-ranger-with-an-acute-psychotic-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Elöd Ernö Nagy,1,2 Attila Rácz,3 Edit Urbán,4 Gabriella Terhes,4 Timea Berki,5 Emöke Horváth,6 Anca M Georgescu,7 Iringó E Zaharia-Kézdi71Department of Pharmaceutical Biochemistry, University of Medicine and Pharmacy of Târgu-Mureş, 2Laboratory of Medical Analysis, Mures Clinical County Hospital, 3II. Psychiatry Clinic, Mures Clinical County Hospital, Târgu Mureş, Romania; 4Faculty of Medicine, Institute of Clinical Microbiology, University of Szeged, Szeged, 5Faculty of Medicine, Institute of Immunology and Biotechnology, University of Pécs, Pécs, Hungary; 6Department of Pathology, 7I. Clinic of Infectious Disease, University of Medicine and Pharmacy, Târgu Mureş, RomaniaAbstract: The identification and distinction of the pathological conditions underlying acute psychosis are often challenging. We present the case of a 35-year-old ranger who had no history of acute or chronic infectious disease or any previous neuropsychiatric symptoms. He arrived at the Psychiatry Clinic and was admitted as an emergency case, displaying bizarre behavior, hallucinations, paranoid ideation, and delusional faults. These symptoms had first appeared 7 days earlier. An objective examination revealed abnormalities of behavior, anxiety, visual hallucinations, choreiform, and tic-like facial movements. After the administration of neuroleptic and antidepressant treatment, he showed an initial improvement, but on day 10 entered into a severe catatonic state with signs of meningeal irritation and was transferred to the intensive care unit. An electroencephalogram showed diffuse irritative changes, raising the possibility of encephalitis. Taking into consideration the overt occupational risk, Borrelia antibody tests were prescribed and highly positive immunoglobulin (Ig)M and IgG titers were obtained from serum, along with IgG and antibody index positivity in cerebrospinal fluid. In parallel, anti-N-methyl-D-aspartate receptor antibodies and a whole battery of other autoimmune encephalitis markers showed negative. A complex program of treatment was applied, including antibiotics, beginning with ceftazidime and ciprofloxacin – for suspected aspiration bronchopneumonia – and thereafter with ceftriaxone. A gradual improvement was noticed and the treatment continued at the Infectious Disease Clinic. Finally, the patient was discharged with a doxycycline, antidepressant, and anxiolytic maintenance treatment. On his first and second control (days 44 and 122 from the disease onset), the patient was stable with no major complaints, Borrelia seropositivity was confirmed both for IgM and IgG while the cerebrospinal fluid also showed reactivity for IgG on immunoblot. On the basis of the putative occupational risk, acute psychotic episode, and the success of antibiotic therapy, we registered this case as a late neuroborreliosis with atypical appearance.Keywords: Borrelia burgdorferi, neuroborreliosis, neuropsychiatric symptoms, encephalitis, anti-NMDARNagy EERácz AUrbán ETerhes GBerki THorváth EGeorgescu AMZaharia-Kézdi IEDove Medical PressarticleBorrelia burgdorferineuroborreliosisneuropsychiatric symptomsencephalitisanti-NMDARNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2016, Iss Issue 1, Pp 961-967 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Borrelia burgdorferi neuroborreliosis neuropsychiatric symptoms encephalitis anti-NMDAR Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Borrelia burgdorferi neuroborreliosis neuropsychiatric symptoms encephalitis anti-NMDAR Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Nagy EE Rácz A Urbán E Terhes G Berki T Horváth E Georgescu AM Zaharia-Kézdi IE Diagnostic pitfalls in a young Romanian ranger with an acute psychotic episode
description	Elöd Ernö Nagy,1,2 Attila Rácz,3 Edit Urbán,4 Gabriella Terhes,4 Timea Berki,5 Emöke Horváth,6 Anca M Georgescu,7 Iringó E Zaharia-Kézdi71Department of Pharmaceutical Biochemistry, University of Medicine and Pharmacy of Târgu-Mureş, 2Laboratory of Medical Analysis, Mures Clinical County Hospital, 3II. Psychiatry Clinic, Mures Clinical County Hospital, Târgu Mureş, Romania; 4Faculty of Medicine, Institute of Clinical Microbiology, University of Szeged, Szeged, 5Faculty of Medicine, Institute of Immunology and Biotechnology, University of Pécs, Pécs, Hungary; 6Department of Pathology, 7I. Clinic of Infectious Disease, University of Medicine and Pharmacy, Târgu Mureş, RomaniaAbstract: The identification and distinction of the pathological conditions underlying acute psychosis are often challenging. We present the case of a 35-year-old ranger who had no history of acute or chronic infectious disease or any previous neuropsychiatric symptoms. He arrived at the Psychiatry Clinic and was admitted as an emergency case, displaying bizarre behavior, hallucinations, paranoid ideation, and delusional faults. These symptoms had first appeared 7 days earlier. An objective examination revealed abnormalities of behavior, anxiety, visual hallucinations, choreiform, and tic-like facial movements. After the administration of neuroleptic and antidepressant treatment, he showed an initial improvement, but on day 10 entered into a severe catatonic state with signs of meningeal irritation and was transferred to the intensive care unit. An electroencephalogram showed diffuse irritative changes, raising the possibility of encephalitis. Taking into consideration the overt occupational risk, Borrelia antibody tests were prescribed and highly positive immunoglobulin (Ig)M and IgG titers were obtained from serum, along with IgG and antibody index positivity in cerebrospinal fluid. In parallel, anti-N-methyl-D-aspartate receptor antibodies and a whole battery of other autoimmune encephalitis markers showed negative. A complex program of treatment was applied, including antibiotics, beginning with ceftazidime and ciprofloxacin – for suspected aspiration bronchopneumonia – and thereafter with ceftriaxone. A gradual improvement was noticed and the treatment continued at the Infectious Disease Clinic. Finally, the patient was discharged with a doxycycline, antidepressant, and anxiolytic maintenance treatment. On his first and second control (days 44 and 122 from the disease onset), the patient was stable with no major complaints, Borrelia seropositivity was confirmed both for IgM and IgG while the cerebrospinal fluid also showed reactivity for IgG on immunoblot. On the basis of the putative occupational risk, acute psychotic episode, and the success of antibiotic therapy, we registered this case as a late neuroborreliosis with atypical appearance.Keywords: Borrelia burgdorferi, neuroborreliosis, neuropsychiatric symptoms, encephalitis, anti-NMDAR
format	article
author	Nagy EE Rácz A Urbán E Terhes G Berki T Horváth E Georgescu AM Zaharia-Kézdi IE
author_facet	Nagy EE Rácz A Urbán E Terhes G Berki T Horváth E Georgescu AM Zaharia-Kézdi IE
author_sort	Nagy EE
title	Diagnostic pitfalls in a young Romanian ranger with an acute psychotic episode
title_short	Diagnostic pitfalls in a young Romanian ranger with an acute psychotic episode
title_full	Diagnostic pitfalls in a young Romanian ranger with an acute psychotic episode
title_fullStr	Diagnostic pitfalls in a young Romanian ranger with an acute psychotic episode
title_full_unstemmed	Diagnostic pitfalls in a young Romanian ranger with an acute psychotic episode
title_sort	diagnostic pitfalls in a young romanian ranger with an acute psychotic episode
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/40559a18e6784a06960c8c01c76de575
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Diagnostic pitfalls in a young Romanian ranger with an acute psychotic episode

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