Encephalitis secondary to nitrous oxide and vitamin B12 deficiency

A 27-year-old woman presented with confusion, agitation and fever. Having initially been treated as an infective encephalitis case her initial and subsequent lumbar punctures revealed cerebrospinal fluid with a worsening pleocytosis and elevated protein. It was initially felt she had been suffering...

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Bibliographic Details
Published in:BMJ case reports Vol. 12; no. 12; p. e229380
Main Authors: Hughes, Gareth, Moran, Ed, Dedicoat, Martin J
Format: Journal Article
Language:English
Published: London BMJ Publishing Group Ltd 02.12.2019
BMJ Publishing Group LTD
BMJ Publishing Group
Series:Case report
Subjects:
Anemia
Antigens
Case reports
Drug misuse (including addiction)
Encephalitis
Fever
Glucose
Hepatitis
Immunoglobulins
Nitrous oxide
Patients
Peripheral neuropathy
Proteins
Reminder of Important Clinical Lesson
TB and other respiratory infections
Tuberculosis
Urine
ISSN:1757-790X, 1757-790X
Online Access:Get full text
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Summary:A 27-year-old woman presented with confusion, agitation and fever. Having initially been treated as an infective encephalitis case her initial and subsequent lumbar punctures revealed cerebrospinal fluid with a worsening pleocytosis and elevated protein. It was initially felt she had been suffering from tuberculous meningitis and started on treatment it later became apparent that she had a severe vitamin B12 deficiency related to recreational nitrous oxide use. She also was noted to have a peripheral neuropathy. After replacing her vitamin B12 and later stopping her tuberculous medication once cultures were negative her cognition and peripheral neuropathy continued to improve.
Bibliography:Case report
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ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-229380