1. Japanese encephalitis over left thalamic and left P-O cortical lesion
5 days before Day 1 Day 5
Mr. Chen 44 y/o. Px: HTN
5 days before Day 1
0
0
3
30
0 3
3
Mr. Chen 44 y/o. Px: HTN
Unable to communicate
Slurred speech
5 days before Day 1
0
0
3
30
0 3
3
Mr. Chen 44 y/o. Px: HTN
Unable to communicate
Slurred speech
WBC: 8.53
CRP: 3.11 ⬆
Cre: 1.8 ⬆
K: 3.0 ⬇
WBC: 145 /uL ⬆
Protein: 95.1 ⬆
Glucose: 79
MRI when admission
Bilateral thalamus, especially L’t
Left cerebral peduncle
Left upper pons
WBC: 8.53
CRP: 3.11 ⬆
Cre: 1.8 ⬆
K: 3.0 ⬇
WBC: 145 /uL ⬆
Protein: 95.1 ⬆
Glucose: 79
Seg:14.5%
5 days before Day3
Mr. Chen 44 y/o. Px: HTN
Tea color urine
Respiratory distress
Spiking fever
Mr. Chen 44 y/o. Px: HTN
WBC: 16.0 ⬆
Cre: 1.4 ⬆
GOT: 1004 ⬆
GPT: 254 ⬆
CK: 68600 ⬆
Urine Myoglobulin
Mr. Chen 44 y/o. Px: HTN
WBC: 16.0 ⬆
Cre: 1.4 ⬆
GOT: 1004 ⬆
GPT: 254 ⬆
CK: 68600 ⬆
Urine Myoglobulin
Multi-organ involvement
Acyclovir
Doxycycline / Claforan
Day 1
Day 3
DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8 DAY9
Light reflex / - / - - + + + +
Oculomotor - - - - (L’t) - (L’t) - (L’t) - (L’t)
Corneal reflex - - - - -
Babinski sign Bil. dorsi-
Bil. dorsi-
Bil. dorsi-
Bil. dorsi-
Bil. dorsi-
GCS E1VTM2 E1VTM3 E1VTM3 E1VTM3 E1VTM3
1st JE. IgM: Negative
Influenza A,B: Negative
HIV : Negative
HSV/ CMV/ VZV : Negative
Lepto/ Lyme : Negative
All culture: Negative
CT when day 7
Bilateral thalamus
Bilateral cerebral peduncle
Bilateral pons
MRI when day 10
Bilateral thalamus, especially L’t
Bilateral midbrain, especially L’t
Bilateral pons, especially L’t
Leptomeaneal enhancement, L’t
2nd JE. IgM: Positive
Mr. Chen 44 y/o. Px: HTN
Final diagnosis
1. Japanese encephalitis over bilateral thalamic, pontine, midbrain lesion and left leptomeningeal enhancement2. Atypical infection with hepatic and renal impairment and rhabdomyolysisAutoimmune?