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Need Advice
tjwRN posted:
17 year old male. C/O migraine. Found on floor unresponsive. EMS arrives. Male becomes combative and remains combative while in ER. Head CT negative. Male intubated to do lumbar puncture. Results unknown at this time. Male had 104 temp yesterday. WBC's WNL. Any additional testing, we as family, should request. Any guesses, besides meningitis, you might have?
allie_bf responded:
You can not r/o illicit drug use in this situation, although I suspect it will not be easy to raise the question. While the possibility of meningitis had to be investigated, the fever may not be infectious. If an adverse drug reaction could be eliminated, another avenue to consider would be an autoimmune disorder, although it would be pretty unusual for so abrupt an onset. I recall that when my daughter was first dx'd with juvenile arthritis, she had a similar temp spike, and was also pretty out of it, although not to that degree. The doctors cultured everything, only to have her joint pain "kick in" with a vengeance several days later, providing an answer when all of the cultures came back negative. I hope they find an answer soon for your young relative.

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