ABSTRACT
We describe a case of gonococcal spontaneous bacterial peritonitis (SBP) in a 48-year-old sexually active female with alcoholic cirrhosis and chronic hepatitis B. She was admitted with fever, abdominal pain and distension without dysuria, dyspareunia, or vaginal discharge. On exam, she was icteric with features of sepsis and tense ascites. She underwent paracentesis. The ascitic fluid analysis revealed a neutrophil count of 1,050/µL, and culture grew Neisseria gonorrhoeae. Pelvic examination findings were negative for pelvic inflammatory disease; however, an endocervical swab was positive for N. gonorrhoeae by PCR. She was diagnosed with spontaneous bacterial peritonitis secondary to N. gonorrhoeae and was successfully treated with a seven-day course of IV ceftriaxone. N. gonorrhoeae spontaneous bacterial peritonitis is an extremely rare entity reported only twice despite the high prevalence of gonorrhoeae in the general population. We hypothesize that gonococcal SBP may be frequently undiagnosed since it responds to empiric antibiotics used to treat SBP. It is important for the clinician to be aware of gonococcus as a rare but potential pathogen in SBP. Future studies are needed to determine if routine gonococcal screening in SBP cases would be of clinical utility.
ABSTRACT
Herpes simplex virus 1 infection is a common cause of encephalitis (HSVE) in the United States. Post-HSVE development of N-methyl-D-aspartate receptor (NMDAR) antibodies resulting in autoimmune encephalitis is a rare complication, primarily affecting children and young adults. Anti-NMDAR develops 1-4 weeks after HSVE, manifesting as choreoathetosis and/or orofacial dyskinesia in children and psychiatric symptoms in young adults. We describe a case of a 61-year-old male who presented with agitation, behavioral changes, and confusion eight months after being treated for HSVE. Extensive investigation was unrevealing except for cerebrospinal fluid lymphocytic pleocytosis, a positive anti-NMDAR Ab titer 1 : 64, and imaging changes consistent with postviral encephalitis suggestive of HSV-induced anti-NMDAR encephalitis. Aggressive therapy resulted in limited success and persistent neurologic deficits. The unique features of this case are the old age of the patient and preceding HSVE which triggered this autoimmune process. Physicians should consider anti-NMDAR encephalitis in the differentials for relapsing patients after HSVE.
