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Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e3181f47394
Case Reports

Differential Diagnosis of a Patient With Rhomboencephalitis: Case Study

Michael, L. Madison MD*; Mazumder, Shirin A. MD†; Gelfand, Michael S. MD†

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Abstract

Rhomboencephalitis is a rare and severe infection that frequently presents as progressive brainstem dysfunction. Most cases reported in the medical literature are associated with a positive and specific microbial etiology that is clearly documented by blood, cerebrospinal fluid (CSF), or brain tissue culture. However, some patients with rhomboencephalitis have a negative culture workup, which can lead to a delay in treatment initiation as a differential diagnosis is made. Because a high mortality rate has been associated with a delay in antibiotic therapy for patients with rhomboencephalitis, an improved index of suspicion is needed for early diagnosis.

Recently, the authors cared for a patient with a culture-negative rhomboencephalitis that was successfully treated with empiric antibiotic management. The patient was a 36-year-old woman with symptoms of fever, nausea, and dysphagia. Imaging revealed a right-sided intra-axial contrast-enhancing lesion at the pontomedullary junction, but an exhaustive laboratory and imaging workup failed to reveal a definite etiology. The patient was then given a 6-week course of meropenem, linezolid, and acyclovir to cover possible pathogens, and she ultimately made a complete neurological recovery.

© 2011 Lippincott Williams & Wilkins, Inc.

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