Sheehan’s syndrome misdiagnosed as encephalitis

Case Presentation

A 48-year-old female patient was admitted to the Neurology department because of abnormal mental behavior.

Physical Examination

• The meningeal sign was negative.
• The pupil diameter was about 3 mm.
• The photosensitive, tendon reflex, pathological sign, and physiologic reflex were negative. 
• The liver function test indicated that aspartate aminotransferase levels were high.
• The blood sugar of the patient was normal.
• Physical examination of the digestive, circulatory, and respiratory systems was normal.
• Electrolytes and blood lipids were abnormal. CT head was normal. 

Medical History

• The patient had a history of postpartum haemorrhage 15 years ago.
• She also had postpartum lactation failure and amenorrhea, three pregnancies, and three deliveries. 

Family History

• No family history of similar complaints was found.

Clinical Examination

• The patient has a mental disorder after catching a cold, characterized by self-talk, involuntary movements of hands and feet, hallucinations, and auditory hallucinations.
• The patient’s symptoms changed to silence after 2 days. 
• The patient did not communicate with her family members, did not open her eyes, had no fever, cough, headache, expectoration, convulsion, dyspnoea, or consciousness disorder. 
• Since the disease’s onset, the patient’s mental status was poor and the diet was reduced.

Treatment

• Antiviral treatment was administered but the therapeutic effect was not ideal. 
• Examination of medical history demonstrated that the patient had a history of postpartum haemorrhage. 
• Combined with the haemorrhage history and examination results the patient has been treated with prednisone 5 mg in the morning and 2.5 mg in the evening, and levothyroxine 25 μg was taken orally once a day.

Clinical Outcome

• The patient’s mental disorder improved after 3 days of treatment 
• The electrolyte and blood lipid of the patient significantly improved after 10 days of treatment. 
• The mental symptoms of the patients were also improved.
• After 1 month the patient recovered to a normal state.