Results
The patient’s mental status started to improve over the next 24 hours; he became more cooperative, started responding to commands, and was successfully extubated. The neurological examination after extubating which included cranial nerves, muscle strength and sensation, and tendon reflexes were all unremarkable, although he still has neck stiffness and limited hip flexion due to muscle pain. The patient remained slightly confused and exhibited some degree of unusual behavior and language use noticeable by his parents. He complained of some muscle aches and headaches. The decision to discontinue antibiotics, acyclovir, and dexamethasone was made after 4 complete days of treatment as the etiology of his illness was likely from EBV infection.
His clinical and mental status gradually improved with supportive and symptomatic treatment. By the fourth day of admission, his mental status was back to normal baseline. He was able to walk around with minimal muscle aches and a mild posterior headache. The patient continued to exhibit no neurological deficit. Eventually, he was discharged home by the seventh day.
Table 4: CSF Microbiology Panel