A patient with headache and fever

Case presentation

A 19-year-old right-handed woman was admitted with a progressive, 10-day history of headache, malaise, fever and dysarthria. The headache was increasingly severe and refractory to analgesia. She experienced phonophobia, photophobia, tinnitus and recurrent vomiting. She had pain in her lower back and legs. She was a student and had been previously healthy. She did not smoke or take recreational drugs and drank little alcohol. She had not travelled abroad in the previous year, but her father was from an area of higher tuberculosis (TB) prevalence. On examination, she was confused and dysarthric but orientated to time and place. Upper limb reflexes were brisk. She was in painful urinary retention.

Urine culture was positive for Escherichia coli. She was started on oral amoxicillin and underwent urethral catheterisation. On day 2 of admission, she developed meningism, opsoclonus and stimulus-sensitive myoclonus. Funduscopy was unsuccessful due to opsoclonus. She had an unusual and…

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