A 45-Year-Old Woman Who Feels 'Like a Zombie'

Jeffrey S. Forrest, MD; Alexander B. Shortridge

Disclosures

June 24, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 45-year-old woman presents to her primary care physician stating that she feels "like a zombie." The patient tearfully reports that she has been unable to work or even drive because her mind has not been functioning like it had before a recent illness.

The patient reported that her symptoms began 3 weeks earlier, when she was diagnosed with influenza A. She reported several urgent care visits, in which she had been instructed to take a promethazine/codeine cough syrup, albuterol inhaler, oseltamivir for influenza attenuation, doxycycline for antibiotic coverage, prednisone for respiratory symptom control, and guaifenesin/dextromethorphan for cough symptom control. In the first 2 weeks of her presentation, her coughing was constant and productive, keeping her awake at night. The patient states that she believes her thoughts began slowing a few days into her recent upper respiratory illness; however, she was unsure because of how acutely ill she had been feeling. She has also had increased nightmares about war zones and death.

The patient reports that she has continued to experience confusion and sedation for weeks, even after her upper respiratory symptoms abated. The patient states that she had not felt this sedated since she had taken trazodone (50 mg) for insomnia a few years before. The patient stated she had been knocked out for most of the day after she took that medication.

The patient also reports numbness on the left side of her face and an unusual sensation in her left eyeball. She is worried that she has had a stroke. The patient also reports continuing waves of a "fast heartbeat" that she can feel. She further attests to having to change her sheets at night because of night sweats. These night sweats had slowly started to decrease in frequency before her presentation. The patient also stated that she has occasionally been experiencing hallucinations of "men singing" at night.

In addition to the medications for influenza listed here, the patient reports taking oral contraceptive pills, fluoxetine (60 mg daily) for major depression, topiramate XR (150 mg) daily for migraine prophylaxis, and erenumab injection monthly for migraine prophylaxis.

Her past medical history includes major depression that was diagnosed 20 years prior; it has been stable on fluoxetine. She also reports scoliosis (four childhood surgeries), posttraumatic stress disorder, appendectomy, and a cesarean delivery 15 years prior.

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