Lack of cardinal symptoms of meningitis in a hospitalized patient with chronic schizophrenia: lessons to be learned.
OBJECTIVE
There are prior reports describing a diagnostic delay in medical emergencies in patients with schizophrenia. To our knowledge, this is the first case report demonstrating the risk of diagnostic delay of acute meningitis due to reduced pain perception as well as other factors related to schizophrenia and its treatment.


METHODS
We report a case of meningitis in a patient suffering from chronic schizophrenia and poor treatment response despite high doses of antipsychotics. Potential difficulties and pitfalls when suspecting or diagnosing meningitis as a physical comorbidity in patients with schizophrenia are discussed.


RESULTS
A 33-year-old man with chronic and treatment-resistant schizophrenia developed acute meningitis. The definite diagnosis was delayed because the cardinal symptoms other than fever were not clearly elicited by physical examination. The characteristic symptoms of meningitis were concealed by reduced pain perception, rigidity due to the administration of antipsychotics, disorganized thinking and potentially diminished communication with health care professionals as commonly seen in patients with schizophrenia.


CONCLUSIONS
Meningitis should not be dismissed as a possibility in patients with fever of unknown origin just because a patient with schizophrenia does not present with cardinal features of meningitis other than fever.
Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan; 3-16 Shikatahonmachi, Kita Ward, Okayama 700-0915, Japan. Electronic address: nexttext@gmail.com.
Ryuhei
R
So
Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco, San Francisco, CA. Electronic address: tomoya.hirota@ucsf.edu.
Tomoya
T
Hirota
Department of Infection Control & Prevention, Department of Clinical Laboratory Medecine, Kurashiki Central Hospital, Okayama, Japan. Electronic address: yy14429@kchnet.or.jp.
Yuki
Y
Yamamoto
Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: hishipon@med.kobe-u.ac.jp.
Akitoyo
A
Hishimoto
Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, NY, USA. Electronic address: ccorrell@lij.edu.
Christoph U
CU
Correll
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D057210:Delayed Diagnosis; D006801:Humans; D008297:Male; D008581:Meningitis / Q000150:complications / Q000175:diagnosis*; D012559:Schizophrenia / Q000150:complications* / Q000188:drug therapy
D014150:Antipsychotic Agents
Acute Disorder; Internal Medicine; Meningitis; Neuropsychiatry; Schizophrenia