A 55 year old Indonesian male known case of DM on oral hypoglycaemic drugs presented to ER with productive cough for 3 days. He had no history of SOB, neither haemoptysis, vomiting, haematuria nor bleeding. On physical examination, he appeared disoriented agitated, pale, jaundiced and with good body built. He was not distressed without any cyanosis, clubbing or sign of dehydration. His temperature was 39.3˚C. Laboratory investigation revealed WBC count of 22 /ml, HB 7, 5 gm/dl normochromic normocytic anaemia, normal platelet and normal AB, random blood sugar 320 ml/dl, urea 140 ml/dl, creatinine 2.5 ml/dl , LDL 1500, total bilirubin 3 mainly indirect. CT brain was clear. CSF analysis showed 10 cells 100% lymphocytes, protein 100mg/dl (high) and glucose 160 mg/dl (normal). The patient was initially treated with I.V hypertonic saline, ceftriaxone, vancomycin, acyclovir and dexamethasone, insulin and diet management. Two days later. patient showed improvement in his level of conscious as his Na become 121 mg/dl, urine output 600ml/day, but patient still had high grade fever ongoing haemolysis, erythromycin was started and an obvious improvement happened, he become communicating, afebrile, LDH decrease from 2000 to 750, with increase HB level from 6,5 g/dl to 9 g/dl. Conclusively, Aseptic meningitis should be considered in patient with mycoplasma pneumonia presented with confusion despite he has hypernatremia.
