56-Year-Old Man Develops Altered Mental Status After Fever – Diagnosed with Meningoencephalitis

In this clinical case, a 56-year-old male patient presented with high fever and progressive confusion, ultimately diagnosed with meningoencephalitis at The Second Affiliated Hospital of Harbin Medical University in February 2022. This article explores the symptoms, diagnostic process, treatment plan, and recovery journey of the patient, offering valuable insights into the importance of early detection and timely intervention for central nervous system infections.

Understanding Meningoencephalitis: A Potentially Life-Threatening Condition

Meningoencephalitis is an inflammatory condition affecting both the brain tissue (encephalitis) and the surrounding membranes (meningitis). It often presents with non-specific symptoms such as fever, headache, nausea, and altered mental status, which can rapidly progress if left untreated. Depending on the area of the brain involved, patients may experience seizures, behavioral changes, or even loss of consciousness. Early diagnosis through imaging and cerebrospinal fluid analysis is crucial to prevent severe neurological complications.

Patient Profile and Initial Presentation

The patient was a 56-year-old man with a medical history of hypertension and type 2 diabetes. Four days prior to hospitalization, he developed a sudden onset of high-grade fever ranging between 38.5°C and 39.6°C without any clear trigger. He also reported mild but persistent headaches accompanied by a sensation of fullness in the head and nausea—though no vomiting occurred.

Progression of Neurological Symptoms

Two days before admission, his condition worsened significantly with increasing confusion and drowsiness. While he could be briefly awakened and answer simple questions, he quickly drifted back into a semi-conscious state. There were no signs of limb convulsions or paralysis, prompting urgent medical evaluation to determine the underlying cause of his deteriorating mental function.

Diagnostic Workup and Key Findings

Upon arrival at the hospital, a comprehensive assessment was initiated. Diagnostic procedures included:

• Brain MRI (Magnetic Resonance Imaging)
• Lumbar puncture for cerebrospinal fluid (CSF) analysis
• Blood cultures and complete blood count (CBC)

Imaging revealed multiple lacunar infarcts and ventricular enlargement—findings that suggested chronic vascular changes possibly exacerbated by acute inflammation. However, the lumbar puncture provided the most telling evidence:

• Elevated CSF pressure: 280 mmH₂O
• Increased protein levels: 1027 mg/L
• Moderate pleocytosis: 90 white blood cells
• Normal glucose and chloride levels

These results, combined with the clinical picture, led to a definitive diagnosis of meningoencephalitis, likely of viral origin, though bacterial co-infection could not be ruled out initially.

Treatment Strategy and Multimodal Approach

Given the severity of the condition and the risk of rapid neurological decline, an aggressive treatment protocol was implemented immediately after informed consent was obtained from the patient's family.

Pharmacological Interventions

The treatment regimen included a combination of intravenous medications targeting different aspects of the disease:

• Ganciclovir: Administered to cover potential herpesviruses, a common cause of encephalitis.
• Imipenem/Cilastatin: A broad-spectrum antibiotic used empirically to rule out bacterial meningitis.
• Human Immunoglobulin (IVIG): Given to modulate immune response and support recovery.
• Mannitol Injection: Used to reduce elevated intracranial pressure and prevent cerebral edema.
• Xingnaojing Injection: A traditional Chinese medicine formulation used adjunctively for neuroprotection and consciousness improvement.

In addition to medication, supportive care played a vital role in stabilizing the patient's condition.

Supportive and Symptomatic Care

To manage persistent fever, physical cooling methods such as cooling patches and ice packs were applied regularly. Close monitoring of vital signs ensured prompt response to any fluctuations. Psychological reassurance and calming techniques were also employed to reduce anxiety and agitation associated with delirium.

Recovery and Clinical Outcome

After 12 days of intensive inpatient care, the patient showed marked improvement. His temperature normalized, nausea resolved, and cognitive functions gradually returned. He became fully alert, oriented, and capable of coherent conversation. With stabilized vitals and improved lab parameters, he was discharged with instructions for follow-up care.

A follow-up appointment was scheduled one month post-discharge to assess long-term neurological outcomes and ensure complete resolution of infection. Additionally, due to his diabetic history, referral to an endocrinologist was recommended to optimize glycemic control—a key factor in preventing future infections.

Post-Discharge Recommendations for Optimal Recovery

While the acute phase had passed, ongoing care remained essential for sustained recovery. The following guidelines were emphasized:

Diet and Lifestyle Adjustments

A balanced, nutrient-rich diet was advised, focusing on easily digestible, non-spicy foods. Patients are encouraged to stay well-hydrated and avoid alcohol and tobacco, which can impair healing. Light physical activity such as daily walking was recommended to improve circulation and overall wellness, provided it did not induce fatigue.

Follow-Up and Monitoring

Adherence to scheduled clinic visits is critical. Regular checkups allow healthcare providers to monitor for residual neurological deficits, recurrence, or late complications such as epilepsy or cognitive impairment. Any new symptoms—including headaches, memory issues, or mood changes—should be reported immediately.

Clinical Insights and Preventive Perspective

This case highlights how a seemingly common symptom like fever can signal a serious neurological emergency when accompanied by altered mental status. Delayed treatment of meningoencephalitis increases the risk of devastating consequences, including seizures, hydrocephalus, brain abscesses, stroke from vasculitis, and even death due to brain herniation from uncontrolled intracranial pressure.

Early recognition, rapid diagnostics, and immediate initiation of appropriate therapy dramatically improve prognosis. Individuals with chronic conditions like diabetes should be especially vigilant about infections, as they are more susceptible to severe forms of illness. Public awareness and access to timely medical care remain pivotal in reducing morbidity and mortality related to central nervous system infections.