Altered mental status in a case of multiple myeloma not related to a metabolic cause

Table 1. Demographic data of the reported patients on dialysis with Chryseobacterium meningosepticum infection Gender/ Dialysis Access for Source of Initial Reference age modality dialysis infection Consequence antibiotics Outcome [2] F/33 CAPD a Tenckhoff Dialysate Peritonitis Not respond Not remove access, catheter effluent (TOB + VAN) survival [3] F/76 CAPD Tenckhoff Dialysate effluent Peritonitis; Not respond Remove access, catheter Blood bacteraemia (CTZ + GM + VAN) died [3] UA/14 CAPD Tenckhoff Blood Sepsis Not respond Remove access, catheter (NAF + GM) died [3] F/63 CAPD Tenckhoff Dialysate Peritonitis Not respond Remove access, catheter effluent (AZT+ PIP) survival [3] F/45 CAPD Tenckhoff Dialysate Peritonitis Not respond Not remove access, catheter effluent (IMI and TOB) survival [4] M/54 CAPD Tenckhoff Dialysate Peritonitis Not respond Remove access, catheter effluent (CZL + GM) survival [2] 33 cases CAPD Tenckhoff Dialysate Peritonitis NA Remove access: (30 episodes) catheter effluent bacteraemia NA 1 died, 31 HD b (4 episodes) NA Blood survival. [2] M/74 HD Arteriovenous Blood Bacteraemia; Not respond Remove access, graft purulent (MER) died pericarditis [5] M/78 CAPD Tenckhoff Dialysate Peritonitis Respond Not remove access, catheter effluent (CIP + RIF) survival Our case F/77 HD Femoral vein Tip of the Bacteraemia Not respond Remove access, catheter catheter (VAN + RIF) survival a CAPD; continuous ambulatory peritoneal dialysis. b HD: haemodialysis. Antimicrobial susceptibility of flavobacteria as determined by agar dilution and disk diffusion methods. Altered mental status in a case of multiple myeloma not related to a metabolic cause Sir, Altered mental status (AMS) in a patient with multiple myeloma (MM) is generally attributed to uremia, hyper-calcemia, hyperviscosity and/or increased serum ammonia. We present an unusual case of altered mental status that could not be attributed to metabolic encephalopathy. Our patient was a 68-year-old African American male who was admitted for AMS. The patient was asymptomatic 1 week prior to admission. On examination, no focal neu-rologic deficit other than altered sensorium was found. The rest of his physical examination was normal. Routine laboratory analysis revealed elevated BUN of 58 mg/dl (7– 25 mg/dl), creatinine of 4.9 mg/dl (0.7–1.4 mg/dl), calcium of 12.1 mg/dl (8.5–10.3 mg/dl), total protein of 9.6 g/ dl (5.5–9 g/dl) and serum ammonia of 65 mcg/dl (35– 65 mcg/dl) with normal liver function tests. A toxicology screen was negative. Intravenous hydration with normal saline was initiated. Magnetic resonance imaging (MRI) of brain showed chronic microvascular ischaemic changes with no acute infarct. On …