A 59-year-old female patient presented with the complaints of altered mental status and headache associated with nausea, photophobia, phonophobia and dizziness. There was no other significant complaint. There was no reported history of ill contacts, pets in house and tick bites.
Physical examination On examination, she was febrile, an oral temperature of 38.4°C, blood pressure 103/61 mmHg, heart rate 99/min and respiratory rate 18/min. A complete physical examination was benign otherwise. Laboratory investigations White blood cells (WBCs) 6300/mm 3 Red blood cells (RBCs) 3.92 million/mm 3 Hemoglobin 11.7 mg/dL Platelets 123,000/mm 3 Glucose 110 mg/dL Sodium 133 mmol/L Potassium 3.8 mmol/L Creatinine 0.8mg/dL Calcium 8.2 mg/dL Next day she had an episode of high spiking fever reaching (39.4°C) 103°F with WBC dropping to 3500/mm 3 , RBCs to 3.17 million/mm 3 and platelets to…
