Two weeks into her febrile illness, she developed mild transient leukocytosis, which resolved after four days. However, she remained febrile and symptomatic, and so her antibiotics were further broadened. This finally led to improvements in tachycardia and resolution of the fever. After two more weeks of intravenous antibiotic treatment, she was medically cleared for transfer to the psychiatric hospital, with a diagnosis of strep bacteremia. Although it was assumed that this had caused the fever, the etiology of the initial infection remained unclear.

During her stay in the general hospital, the patient experienced “astonishing” improvement in her psychiatric condition, even though all antipsychotic agents had been discontinued, according to the authors. She had a “remarkable absence of psychotic symptoms” and was “psychiatrically stable.” Although her affect remained “constricted,” she was calm and cooperative and without hallucinations. She expressed no delusional or paranoid ideation, her thought processes remained linear and organized, and she displayed no noteworthy bizarre behavior, depressive symptoms, or mania. Her only psychotropic drugs were divalproex monotherapy and PRN lorazepam (which she required only three times during the medical hospitalization).

After being medically stabilized, the patient was transferred back to the psychiatric unit, where she restarted clozapine. Although she continued to display marked improvement in her psychotic symptoms, some of her bizarre behaviors did reemerge. During the 11 remaining weeks as a psychiatric inpatient, she required a total of only eight doses of PRN lorazepam, the majority of which were requested by her for anxiety. She did not require any PRN antipsychotics. Her medication regimen on discharge consisted of divalproex and clozapine—both at lower doses than she had been receiving prior to her infection.

Many of her improvements in psychiatric symptoms were sustained. However, because of her poor baseline function and continued bizarre behavior and mood lability, she was transferred to a state hospital for “presumed long-term hospitalization.”

In discussing the implications of the case study, the authors described research conducted in the 1950s by Moreira and Sager, which found that fevers directly stimulated the hypothalamic pituitary axis (HPA) to release adrenocorticotropic hormone and cortisol, resulting in decreased levels of eosinophils and lymphocytes.3,4 Based on these findings, the authors suggested that these were the mechanisms by which fevers appeared to treat neurosyphilis. Additional studies suggest an interaction between fever and neurotransmitters5,6 and a relationship between the heat shock response relief of oxidative stress and inflammation, which may have utility in treating autism.7