Case 160 -- Fevers and Mental Status Changes

Contributed by Michael Torbenson, MD, A. Julio Martinez, MD and Larry Nichols, MD
Published on line in September 1998


A 35 year-old white female with a diagnosis of acute myelomonocytic leukemia underwent an allogenic bone marrow transplant with good engraftment. Three months later, the patient presented to the Bone Marrow Transplant Clinic for a routine examination. When her Hickman central venous catheter was flushed she became acutely febrile with chills and rigors. She was diagnosed with Klebsiella line sepsis and was treated with 14 days of antibiotics. She was afebrile for the almost the entire course of antibiotics, but began to have nightly fevers once the antibiotics were stopped. A biopsy of a skin lesion showed graft versus host disease. All blood cultures at this time were negative. Empiric antibiotic therapy was began, but the patient continued to have fevers and began to have mental status changes. A computed-tomography scan of the head was negative, but she soon began to have seizures. She continued to decline with hypotension and respiratory failure and died on the 18th hospital day. A full autopsy was performed.



Case IndexCME Case StudiesFeedbackHome