PSY1 Eastern equine encephalitis presenting as psychosis. (Psychiatry and Neurology).

PSY1 EASTERN EQUINE ENCEPHALITIS PRESENTING AS PSYCHOSIS. Todd M. Hrabak, DO, Michael Yerkey, MD, and Keith Graham, MD. Keesler Air Force Base, Biloxi, Miss.

A 24-year-old woman presented with generalized tonicclonic seizures, initially presumed due to ethanol intoxication. She manifested marked personality changes such as withdrawn behavior, visual hallucinations and thought blocking. Initial evaluation was unremarkable, including head CT. Benztropine, thioridazine and lorazepam were administered for psychosis. While awaiting transfer for inpatient psychiatric care she developed musculoskeletal rigidity, with fever to 101[degrees]F and CK 11,000. Antipsychotics were held and treatment begun for neuroleptic malignant syndrome (NMS) with bromocryptine, amantadine and dantrolene. Lumbar puncture revealed 45 WBC's, 98% lymphocytes. On the sixth hospital day serologies were sent and returned positive for eastern equine encephalitis virus, IgM 1:32 and IgG 1:64 (normal < 1:16). Local public health officials noted a recent cluster of equine encephalitis in the cattle population as well as two confirmed human cases, both of which were fatal. Supportive care was continued , and the patient demonstrated progressive improvement in neurologic function. Eastern equine encephalitis is a rare disease occuring sporadically along the Gulf Coast. Initial symptoms are non-specific and include headache, fever, irritability, nausea, seizures and coma. Eastern equine encephalitis carries a mortality, of over 30%, and most patients who survive have residual neurologic deficits. No specific therapy is available. This case is of interest because the patient initially presented with psychosis. Clinical suspicion is the most important determinant of diagnosis, which allows accurate determination of prognosis. Alerting public health authorities early may allow for better vector control.