Case 150 – update 3

Our patient’s seizure was short lived and self-terminated. Her blood cultures grow E. coli. CT head is clear. She undergoes a lumbar puncture and the microbiology lab are able to see Gram negative bacilli in her CSF. She is commenced on appropriate antibiotics.

After 48h she has not had any further seizures but remains pyrexial, now with profuse diarrhoea and an eosinophil count of 19 x10^9/L.

Some of her tests have come back:

-Peripheral blood cytogenetics: negative for BCRABL, PDGFRAPDGFRB and FGFR1
-HBV serology: HBsAb positive, HBsAg negative, HBcAb negative
-HCV PCR: not detected
-HIV PCR: detected
-Vasculitis screen: negative
-Echocardiogram: normal
-ECG: normal
-Stool: C diff negative, but culture still in progress

What would you do at this point?

And why is her eosinophilia getting worse despite antibiotics?

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