A 77-year-old male presented from a rehabilitation facility for acute onset of confusion,
significant pain in his neck and extremities, muscle rigidity and subjective fever.
Comorbidities included Parkinson disease, Lewy body dementia, anxiety, depression
and recent right shoulder surgery complicated by pulmonary embolism, for which he
was started on apixaban. On admission, physical exam revealed severely limited range
of motion in the neck, diffuse rigidity and weakness in all extremities, diffuse joint
pain with movement of extremities and neck, and disorientation. His temperature was
37.6°C and initial investigations revealed a leukocytosis with white blood cell count
of 14 thousands/microliter, erythrocyte sedimentation rate of 115 mm/h, C-reactive
protein of 308 mg/L, urinalysis with numerous white blood cell counts, many bacteria
and leukocyte esterase, with urine culture positive for Klebsiella pneumoniae and Enterococcus faecalis. An acute tick-borne panel was subsequently negative.
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Article Info
Publication History
Published online: April 24, 2022
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
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