Psittacosis Combined With Central Nervous System Infection and Acute Cerebral Infarction: A Case Report Based on Metagenomic Next-Generation Sequencing.

Introduction: The diagnosis of psittacosis is still challenging due to the high risk of underdiagnosis and misdiagnosis. Here, we reported our diagnostic experience with psittacosis in combination with central nervous system (CNS) infection and acute cerebral infarction (CI).

Case report: A 62-year-old gentleman presented to our department due to episodic vertigo for 4 hours. Pulmonary CT scan revealed high-density shadows in the right upper lobe, and brain MRI initially excluded new CI lesions. Seven days later, the patient began to show fever, with the highest temperature of 39.3°C. Pulmonary CT scan showed pneumonia. Cerebral MR was performed as the patient showed loss of consciousness and convulsion, which indicated pontine infarction. The patient was eventually transferred to the ICU due to severe pneumonia complicated by type I respiratory failure and acute respiratory distress syndrome (ARDS). Metagenomic next-generation sequencing (mNGS) confirmed psittacosis, and then the patient was treated with a regimen of piperacillin-tazobactam, moxifloxacin, and minocycline. However, the patient continued to have a fever and exhibited irritability after withdrawal of sedative medication, thereby, CNS infection was suspected. Upon cerebrospinal fluid collection following lumbar puncture, mNGS sequencing indicated Candida albicans infection. MR revealed progression of infarction featured by increased lesions in the right cerebellum, right pons, right fronto-parietal-temporal-occipital, and right corona radiata.

Conclusion: We reported a case report of psittacosis combined with CNS infection based on the mNGS sequencing, along with acute CI based on conventional imaging technique.