Disclosures: Simon A. Wallace, MD: Nothing to disclose

Case Description: Patient was admitted for post-operative multidisciplinary treatment. Antibiotic therapy for pneumonia was completed shortly after admission. Afterwards, his white blood cell (WBC) count was initially normal at 9.28 ×109/L. Upon recheck 4 weeks later, WBC count was elevated at 25.11 ×109/L, but dropped to 20.88 ×109/L and then 7.35 ×109/L over 2 days with no intervention. C-reactive protein (CRP) was mildly elevated, with a peak of 2.1 mg/dL. Infectious work up was negative. Throughout admission, respiratory status continually improved, and he showed no other signs or symptoms of infection. Over 24 seizures were recorded. Given seizure frequency, there may have been unwitnessed seizures as well. At discharge, WBC count peaked at 31.54 ×109/L and CRP remained slightly elevated at 1.1 mg/dL. The labile WBC counts, mildly elevated CRP, normal erythrocyte sedimentation rate, vital signs within normal limits, and no clear source of infection most likely reflect seizure activity as the cause of abnormal inflammatory markers. He was discharged with recommended PCP follow up within 1 week for repeat labs.

Setting: Short term care unit in residential care facility.

Patient: 18-year-old male with Lennox-Gastaut Syndrome and cerebral palsy status post spinal fusion complicated by aspiration pneumonia.

Assessment/Results: WBC count checked 1 month after discharge was within normal limits.

Discussion: Seizures can produce systemic changes that mimic an inflammatory response to infection. It has been shown that no significant difference in degree of leukocytosis is observed between these clinical scenarios. However, CRP elevation has been found to be milder (<6 mg/dl) in response to seizures compared to concurrent infection.

Conclusion: In patients with known seizure disorders, monitoring inflammatory markers after a recently treated infection requires astute clinical correlation and distinction between an inflammatory-like response secondary to seizures versus concurrent infection.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/interpreting-fluctuating-inflammatory-markers-in-an-adult-with-cerebral-palsy-and-lennox-gastaut-syndrome-after-treatment-for-post-operative-aspiration-pneumonia-a-case-report/