Toxic Psychosis Without Fever as Sign of Acute Meningitis

Acute bacterial meningitis may occasionally present as an afebrile illness with a bizarre psychiatric picture which leads to failure of early diagnosis. In view of the fulminating nature of meningococcic infection, even a few hours' delay in making the diagnosis may mean the difference between death and survival. In 2 patients personally observed, the presenting symptoms of acute psychiatric disturbance initially deceived experienced physicians. In the first case, the patient was originally afebrile and was thought to be hysterical with an incidentally associated gastroenteritis. In the second case, the patient was thought to be schizophrenic. In retrospect, both patients probably had a toxic psychosis which delayed the diagnosis and therefore the treatment of their acute purulent meningitis.

Case 1.—  A 41-year-old Puerto Rican housewife was admitted to the medical service in a semicomatose and disoriented state. At 2 P.M. on the day prior to admission, she complained of a severe