LAUSR

A 70-year-old woman presented to the hospital with chief complaints of altered mental status and hallucinations. Her pertinent medical history was significant for frequent urinary tract infections (UTIs), vascular dementia, depression, and restless legs syndrome (RLS). Pertinent medications included venlafaxine, bupropion, and ropinirole. Over the past 3 years, her mental status had begun to gradually deteriorate. This correlated with a prescription of ropinirole 2 mg at bedtime for RLS with good compliance being reported. On admission, the patient was found to have an UTI and bizarre behavior characterized by vivid hallucinations. Initial vitals were a blood pressure of 131/90 mm Hg, pulse 112 bpm, respiratory rate of 12 bpm, and temperature of 36.6° C. Laboratory results showed a white count of 7.4/ mm3 and urinalysis contained 19 white cells with bacteria present. Ciprofloxacin was initiated for treatment of the UTI. All central nervous system depressant drugs including ropinirole were discontinued. A rapid improvement of her clinical condition and disappearance of her hallucinations were noted after the second day of hospitalization. At this time, ropinirole was restarted for her RLS symptoms at the patient’s request. THERAPEUTIC CHALLENGE