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Meningoencefalitis u bolesnika s mediteranskom pjegavom groznicom = Meningoencephalitis in a patient with Mediterranean spotted fever
Dželalija, Boris ; Petrovec, Miroslav ; Avšič-Županc, Tatjana
We report a case involving a 43-year-old man from the rural area of North Dalmatia with atypical clinically unusual Mediterranean spotted fever (MSF) presenting as a severe form with ...meningoencephalitis. The disease was characterized by high fever, severe headache, maculopapular rash with petechiae and ecchymoses somnolence, hypotension and tachycardia. Laboratory fndings showed abnormal level of white blood count (leukopenia, WBC 2.9x 106) with bands of 18 % in differential blood count, mildly thrombocytopenia (platelets 85X109), elevated levels of aspartate aminotransferase (AST 61 U/L), alanine-aminotransferase (ALT 111 U/L), creatine kinase (CK 545 U/L) andlactic dehydrogenase (LDH 678 U/L), prolonged prothrombin time (1.4); hyperfibrinogenaemia (fibrinogen 5.31 g/L), increased leukocytes with lymphocytes predominance (lymphocytes 314/3) and increased protein concentration (protein 0.76 g/L) in the cerebrospinal fluid. EEG showed mildlydysrhythmic activities. The patient's paired sera were tested by indirect immunofluorescence assay (IFA), using antigen R. conorii, strain Malish 7, and IgM titers of 1:128 /1:1024 and 1gG titers of 1:1024/ 1:1024 were detected. The patient was treated with peroral doxycycline 100 mg X2/7 days. According to our knowledge this is the first case of meningoencephalitiscaused by R. conorii in this region.
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