RESUMO
A patient with morbid obesity and several psychiatric comorbidities underwent laparoscopic sleeve gastrectomy and experienced success with weight loss. However, she experienced lightheadedness, nausea, and a fall and was admitted to the hospital for encephalopathy due to lithium toxicity. The pharmacokinetics of lithium is altered following bariatric surgery. Due to these factors, adjustments were made to the patient's lithium therapy, her levels were subsequently reduced into the therapeutic range, and she continued with no further issues. Mechanisms of lithium toxicity following bariatric surgery and a monitoring protocol to prevent toxicity are discussed.
RESUMO
Most cases of West Nile encephalitis virus (WNV) infection are asymptomatic. In cases where WNV is symptomatic, patients usually experience high fever of sudden onset, myalgia, headache, and gastrointestinal symptoms, accompanied by a macular erythematous rash in a quarter to half of cases. More severe infections manifest as a poliomyelitis. Immunocompromise and immune senescence confer an increased risk of severe central nervous system (CNS) infection. Patients with human immunodeficiency virus (HIV) infection are therefore more susceptible, but, because the symptoms of WNV infection may be attributed to other CNS syndromes common in HIV patients, it is likely that the presence of WNV infection is underdiagnosed and underreported. We present a patient with severe WNV infection who was found to be HIV positive, who also suffered hearing loss. Several key differences in the presentation of WNV infection and Guillain-Barré syndrome that have treatment implications are discussed.
