Mysterious episodic coma

Abstract

The working diagnosis of urinary-tract infection, as a cause of coma, was not entirely convincing: white blood cells were not always present in the patient's urine; blood cultures were consistently negative; on blood testing, the white-cell count and concentration of C-reactive protein were normal; the patient had no fever. Risk factors for bacterial overgrowth syndrome, which is underdiagnosed in elderly patients,1 include anatomical alterations to the intestine, drugs that inhibit gastric acid secretion, diabetes, and advanced age.