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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Published online: April 24, 2022
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
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