Differential diagnosis of a patient with rhomboencephalitis: Case study

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Rhomboencephalitis is a rare and severe infection that frequently presents as progressive brainstem dysfunction. Most cases reported in the medical literature are associated with a positive and specific microbial etiology that is clearly documented by blood, cerebrospinal fluid (CSF), or brain tissue culture. However, some patients with rhomboencephalitis have a negative culture workup, which can lead to a delay in treatment initiation as a differential diagnosis is made. Because a high mortality rate has been associated with a delay in antibiotic therapy for patients with rhomboencephalitis, an improved index of suspicion is needed for early diagnosis.Recently, the authors cared for a patient with a culture-negative rhomboencephalitis that was successfully treated with empiric antibiotic management. The patient was a 36-year-old woman with symptoms of fever, nausea, and dysphagia. Imaging revealed a right-sided intra-axial contrast-enhancing lesion at the pontomedullary junction, but an exhaustive laboratory and imaging workup failed to reveal a definite etiology. The patient was then given a 6-week course of meropenem, linezolid, and acyclovir to cover possible pathogens, and she ultimately made a complete neurological recovery.

Original languageEnglish (US)
Pages (from-to)134-136
Number of pages3
JournalInfectious Diseases in Clinical Practice
Volume19
Issue number2
DOIs
StatePublished - Mar 1 2011

Fingerprint

Differential Diagnosis
Linezolid
meropenem
Anti-Bacterial Agents
Acyclovir
Deglutition Disorders
Nausea
Brain Stem
Cerebrospinal Fluid
Early Diagnosis
Fever
Mortality
Brain
Therapeutics
Infection

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{4512471fe8e24a09af5690ad0a0da226,
title = "Differential diagnosis of a patient with rhomboencephalitis: Case study",
abstract = "Rhomboencephalitis is a rare and severe infection that frequently presents as progressive brainstem dysfunction. Most cases reported in the medical literature are associated with a positive and specific microbial etiology that is clearly documented by blood, cerebrospinal fluid (CSF), or brain tissue culture. However, some patients with rhomboencephalitis have a negative culture workup, which can lead to a delay in treatment initiation as a differential diagnosis is made. Because a high mortality rate has been associated with a delay in antibiotic therapy for patients with rhomboencephalitis, an improved index of suspicion is needed for early diagnosis.Recently, the authors cared for a patient with a culture-negative rhomboencephalitis that was successfully treated with empiric antibiotic management. The patient was a 36-year-old woman with symptoms of fever, nausea, and dysphagia. Imaging revealed a right-sided intra-axial contrast-enhancing lesion at the pontomedullary junction, but an exhaustive laboratory and imaging workup failed to reveal a definite etiology. The patient was then given a 6-week course of meropenem, linezolid, and acyclovir to cover possible pathogens, and she ultimately made a complete neurological recovery.",
author = "Lattimore Michael and Shirin Mazumder and Michael Gelfand",
year = "2011",
month = "3",
day = "1",
doi = "10.1097/IPC.0b013e3181f47394",
language = "English (US)",
volume = "19",
pages = "134--136",
journal = "Infectious Diseases in Clinical Practice",
issn = "1056-9103",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Differential diagnosis of a patient with rhomboencephalitis

T2 - Case study

AU - Michael, Lattimore

AU - Mazumder, Shirin

AU - Gelfand, Michael

PY - 2011/3/1

Y1 - 2011/3/1

N2 - Rhomboencephalitis is a rare and severe infection that frequently presents as progressive brainstem dysfunction. Most cases reported in the medical literature are associated with a positive and specific microbial etiology that is clearly documented by blood, cerebrospinal fluid (CSF), or brain tissue culture. However, some patients with rhomboencephalitis have a negative culture workup, which can lead to a delay in treatment initiation as a differential diagnosis is made. Because a high mortality rate has been associated with a delay in antibiotic therapy for patients with rhomboencephalitis, an improved index of suspicion is needed for early diagnosis.Recently, the authors cared for a patient with a culture-negative rhomboencephalitis that was successfully treated with empiric antibiotic management. The patient was a 36-year-old woman with symptoms of fever, nausea, and dysphagia. Imaging revealed a right-sided intra-axial contrast-enhancing lesion at the pontomedullary junction, but an exhaustive laboratory and imaging workup failed to reveal a definite etiology. The patient was then given a 6-week course of meropenem, linezolid, and acyclovir to cover possible pathogens, and she ultimately made a complete neurological recovery.

AB - Rhomboencephalitis is a rare and severe infection that frequently presents as progressive brainstem dysfunction. Most cases reported in the medical literature are associated with a positive and specific microbial etiology that is clearly documented by blood, cerebrospinal fluid (CSF), or brain tissue culture. However, some patients with rhomboencephalitis have a negative culture workup, which can lead to a delay in treatment initiation as a differential diagnosis is made. Because a high mortality rate has been associated with a delay in antibiotic therapy for patients with rhomboencephalitis, an improved index of suspicion is needed for early diagnosis.Recently, the authors cared for a patient with a culture-negative rhomboencephalitis that was successfully treated with empiric antibiotic management. The patient was a 36-year-old woman with symptoms of fever, nausea, and dysphagia. Imaging revealed a right-sided intra-axial contrast-enhancing lesion at the pontomedullary junction, but an exhaustive laboratory and imaging workup failed to reveal a definite etiology. The patient was then given a 6-week course of meropenem, linezolid, and acyclovir to cover possible pathogens, and she ultimately made a complete neurological recovery.

UR - http://www.scopus.com/inward/record.url?scp=79953120590&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953120590&partnerID=8YFLogxK

U2 - 10.1097/IPC.0b013e3181f47394

DO - 10.1097/IPC.0b013e3181f47394

M3 - Article

AN - SCOPUS:79953120590

VL - 19

SP - 134

EP - 136

JO - Infectious Diseases in Clinical Practice

JF - Infectious Diseases in Clinical Practice

SN - 1056-9103

IS - 2

ER -