A 14-year-old girl was prescribed metronidazole (400 mg tid), metoclopramide (10 mg tid), paracetamol (500 mg tid) and ORS (200 ml pack) for fever, loose stools, and vomiting of 2-day duration. She had taken the above drugs in the morning and in the afternoon. Around 6 pm in the evening, she developed agitation, head ache, difficulty in swallowing and deviation of eyes. She was suspected to have acute encephalitis and computerized tomography (CT) scan of the brain was done. As CT brain was normal she was referred for further management.
On admission in an emergency department, she was conscious, unable to speak and eyes were deviated upwards with hyperextension of the neck. She had rigidity in the neck and upper trunk muscles which mimicked meningeal signs. Her motor and sensory systems were normal. She had no involuntary movements and her pupils were normal in size and reacting. Other…
