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Effect of chronic ranitidine treatment on secretion of intrinsic factor.

A 66-year-old previously healthy Caucasian woman was admitted with a history of fever, myalgia, and malaise for two days and of severe headache for one. She developed photophobia, vomiting, neck stiffness, and a rash on the day of admission. She denied recent trauma or infection but remarked that she and her husband had cleaned out the drains round their house just before she became ill. She frequently played with their pet dog but had never been bitten. On admission she was pyrexial with clinical signs of meningitis and a macular rash confined to the trunk. Other findings were blood white cell count 108X 109/l with 8-9 x 109/l neutrophils. Chest x-ray films showed bilateral basal collapse. Lumbar puncture yielded cloudy cerebrospinal fluid under slightly increased pressure with a white cell count of 575 x 106/1 (nearly all polymorphonuclear leucocytes), protein content 2-4 g/l, and glucose < 1-25 mmol/l (22.52 mg/100 ml). Blood glucose was 5-2 mmol/l (93 70 mg/100 ml). Gram-stained films of cerebrospinal fluid deposit showed large numbers of slender Gram-negative bacilli. Cultures yielded a fastidious Gram-negative bacillus after five days' incubation on Columbia blood agar in an atmosphere containing 7% carbon dioxide. A similar organism was also isolated from blood cultures taken on the day of admission after prolonged incubation of subcultures in an atmosphere of 7% carbon dioxide. Both isolates were finally identified as a dysgonic fermenter type 2 by the Center for Disease Control (Atlanta, Georgia, USA). She was treated for three days with intravenous benzylpenicillin 2 megaunits four hourly and intravenous chloramphenicol 750 mg eight hourly. On day 4 the chloramphenicol regimen was changed to 500 mg orally six hourly, and on day 7 penicillin was discontinued. Chloramphenicol was continued until the tenth day, by which time the patient had been apyrexial for three days and was symptom free. On discharge three days later her recovery was complete with no neurological deficit and chest x-ray films showing only minimal linear collapse in the right lower lobe.