A 19-year-old male undergraduate student of a tertiary educational institution presented to the Accident and Emergency Department of ISTH on 31 March, 2010, with two-day history of fever, vomiting, headache, and neck pain. Fever was high grade and associated with chills and rigors. Fever was transiently relieved by paracetamol. Headache was described as throbbing and generalized; there was associated photophobia and vomiting. He vomited for about five times daily for two days. Vomiting was not described as being projectile, but vomitus contained recently ingested meals. There was no change in bowel habits. He was treated for malaria about three weeks prior to presentation because of fever, vomiting, and headaches; his symptoms resolved following antimalarial use until two days before presenting to our hospital.
There was no history of mucosal bleeding, cough, chest pain, ear pain, or discharge. He neither consumed alcohol nor smoked cigarettes. There was an outbreak of Lassa fever in his town of residence when he was ill, though there was no history of contact with a known case of Lassa fever.
Physical examination showed a young man whose axillary temperature was 38.7 C. He was not pale, icteric, or dehydrated. He had no significant peripheral lymph node enlargement. Pulse rate was 90 beats per minute, blood pressure was 140/80 mmHg, and respiratory rate was 28 cycles per minute. Central nervous system examination revealed a conscious, young boy with neck stiffness and a positive Kernig's sign. The cranial nerves were intact. Motor and sensory systems were normal. There was generalized abdominal tenderness. Other systemic examinations were essentially normal.
A clinical diagnosis of meningitis was made. CSF examination showed elevated white cell count (WBC) with lymphocytes, the predominant cell type. Serum RT-PCR test for LAV was positive. He was commenced on a 10-day course of intravenous ribavirin. Results of investigations are as shown in Table 1.
Patient's symptoms and signs resolved following treatment with ribavirin. He was discharged home in satisfactory condition.