Case 39-1999

Presentation of Case A 74-year-old woman was admitted to the hospital because of diarrhea and fever followed by multiple cranial-nerve palsies. She had a one-week history of fever (temperature, 40°C), watery diarrhea, nausea, abdominal pain, weakness, and fatigue. Her physician prescribed diphenoxylate hydrochloride–atropine sulfate. At 9 p.m. on the day before admission, the patient was speaking normally. She later applied a benzocaine–eugenol preparation to her gingiva because of several hours of dental pain. At 3 a.m. on the next day, her speech became severely slurred. The patient was taken to another hospital. She was able to drink water and to . . .