Lack of cardinal symptoms of meningitis in a hospitalized patient with chronic schizophrenia: lessons to be learned

General Hospital Psychiatry
Ryuhei SoChristoph U Correll

Abstract

There are prior reports describing a diagnostic delay in medical emergencies in patients with schizophrenia. To our knowledge, this is the first case report demonstrating the risk of diagnostic delay of acute meningitis due to reduced pain perception as well as other factors related to schizophrenia and its treatment. We report a case of meningitis in a patient suffering from chronic schizophrenia and poor treatment response despite high doses of antipsychotics. Potential difficulties and pitfalls when suspecting or diagnosing meningitis as a physical comorbidity in patients with schizophrenia are discussed. A 33-year-old man with chronic and treatment-resistant schizophrenia developed acute meningitis. The definite diagnosis was delayed because the cardinal symptoms other than fever were not clearly elicited by physical examination. The characteristic symptoms of meningitis were concealed by reduced pain perception, rigidity due to the administration of antipsychotics, disorganized thinking and potentially diminished communication with health care professionals as commonly seen in patients with schizophrenia. Meningitis should not be dismissed as a possibility in patients with fever of unknown origin just because a patient wit...Continue Reading

References

Aug 1, 1997·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·M L MeterskyA L Rafanan
Jun 13, 2002·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Karen E ThomasVincent J Quagliarello
Oct 29, 2004·The New England Journal of Medicine·Diederik van de BeekMarinus Vermeulen
Apr 21, 2007·Psychiatry Research·Marc De HertJozef Peuskens
Mar 9, 2010·Lancet·Hiroshi MurakamiToshihiro Suda
Mar 8, 2011·World Psychiatry : Official Journal of the World Psychiatric Association (WPA)·Marc DE HertStefan Leucht
Dec 14, 2011·General Hospital Psychiatry·Carolina Retamero, Camille Paglia
Dec 25, 2013·The Journal of Pain : Official Journal of the American Pain Society·Gwenda EngelsErik J A Scherder
Jul 18, 2014·Lancet Neurology·Graham TeasdaleGordon Murray

❮ Previous
Next ❯

Citations

Nov 19, 2019·Journal of Medical Case Reports·Paula LovelandWen Kwang Lim

❮ Previous
Next ❯

Related Concepts

Related Feeds

Antipsychotic Drugs

Antipsychotic drugs are a class of medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia and bipolar disorder. Discover the latest research on antipsychotic drugs here