Medical Case Details:
A 38-year-old male was found wandering outside his apartment building at night wearing only his under garments was brought to the hospital by ambulance and appeared confused. The patient's family later confirmed that for one week prior, he had severe headaches, nausea and vomiting, slurred speech, and confusion. About few months previously, he had presented to another hospital with new onset seizures, was encephalopathic and was found to be hypothyroid. Extensive work-up had ruled out infectious, toxic, metabolic, malignant and paraneoplastic etiologies and Creutzfeldt–Jakob disease. His TSH levels were 8.08 IU/ml. TPOAb and TgAb were markedly elevated TPOAb >900IU/ml with TgAb >3000 IU/ml.
Initial treatment at the outside hospital with a combination of two anticonvulsants was ineffective. However, after 3 days of prednisone (60 mg/d) his seizures resolved.
At our hospital, he is started on broad-spectrum antibiotics for possible infectious meningitis or encephalitis. Lumbar puncture revealed elevated CSF protein levels 221 mg/dl without pleocytosis.
CSF cultures are negative for common bacteria, acid-fast bacilli, fungi, cryptococcus antigen, herpes DNA PCR. Blood and urine cultures are negative and toxicology screening is negative
How to go forward.