Open AccessEncephalitis secondary to nitrous oxide and vitamin B12 deficiency
Author(s) -
G. Hughes,
Ed Moran,
Martin Dedicoat
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-229380
Subject(s) - medicine , pleocytosis , vitamin b12 , encephalitis , lumbar puncture , cerebrospinal fluid , pediatrics , tuberculous meningitis , meningitis , confusion , peripheral neuropathy , anesthesia , surgery , immunology , endocrinology , virus , psychology , psychoanalysis , diabetes mellitus
A 27-year-old woman presented with confusion, agitation and fever. Having initially been treated as an infective encephalitis case her initial and subsequent lumbar punctures revealed cerebrospinal fluid with a worsening pleocytosis and elevated protein. It was initially felt she had been suffering from tuberculous meningitis and started on treatment it later became apparent that she had a severe vitamin B 12 deficiency related to recreational nitrous oxide use. She also was noted to have a peripheral neuropathy. After replacing her vitamin B 12 and later stopping her tuberculous medication once cultures were negative her cognition and peripheral neuropathy continued to improve.