Acute Psychosis Precipitated by Urinary Tract Infection in a Patient with Gliosis of the Basal Ganglia

Philip Lee¹, Filip Oleszak¹, Aditya Nihalani¹, Vinodkumar Velayudhan¹ and Isabel M. McFarlane^1,

¹Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203 USA.

Cite this paper:
Philip Lee, Filip Oleszak, Aditya Nihalani, Vinodkumar Velayudhan and Isabel M. McFarlane. Acute Psychosis Precipitated by Urinary Tract Infection in a Patient with Gliosis of the Basal Ganglia. American Journal of Medical Case Reports. 2019; 7(12):329-333. doi: 10.12691/ajmcr-7-12-7

Abstract

Background: Urinary tract infections (UTI) have been found to be associated with a variety of neuropsychiatric disorders, and could play a role in the pathophysiology of relapse of affective and nonaffective psychosis. In addition, prior history of infarction in areas of the brain such as the cerebellum, basal ganglia, and mid-brain have been reported in patients with new onset psychotic symptoms. Case presentation: A 29-year-old woman was brought to the hospital with acute mental status changes and signs of sepsis. Infectious work-up was initiated including blood cultures, brain imaging, lumbar tap and urinalysis. Brain MRI revealed abnormalities in the basal ganglia and the urinalysis revealed signs of a urinary tract infection (UTI). Further history revealed episodes of mania and depression compatible with bipolar disorder with psychotic features that had acutely worsened. The patient’s condition improved with intravenous antibiotics and the introduction of anti-psychotics. She was discharged in stable condition with outpatient psychiatric follow-up. Conclusion: Infectious diseases (UTIs in particular) are not only more prevalent among patients with acute relapse of psychiatric disorders, but have also been found to have triggered acute psychosis among stable psychiatric patients. Organic brain lesions must be thoroughly investigated among patients presenting with new psychiatric disorders in order to initiate appropriate therapy to control the symptoms.

Keywords:
acute psychosis urinary tract infection mania schizophrenia affective psychosis bipolar disorder with psychotic features gliosis microbiome macrophages blood brain barrier inflammation delusion hallucination mood disorder

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