Is a 61-year-old male with adrenal hyperplasia on low-dose prednisone (corticosteroid) more likely to have febrile seizures if he contracts anaplasmosis (infection)?

Risk of Febrile Seizures in a 61-Year-Old Male with Adrenal Hyperplasia on Prednisone Who Contracts Anaplasmosis

A 61-year-old male with adrenal hyperplasia on low-dose prednisone is not at increased risk for febrile seizures if he contracts anaplasmosis, as febrile seizures primarily affect children between 6-60 months of age and are not associated with adrenal disorders in adults.

Understanding Anaplasmosis and Its Clinical Manifestations

Anaplasmosis is a tickborne rickettsial disease with the following characteristics:

• Typically presents with fever (92-100%), headache (82%), malaise (97%), myalgia (77%), and shaking chills 1
• Central nervous system involvement is rare compared to other tickborne diseases 1
• Cerebrospinal fluid evaluation typically does not reveal abnormalities 1
• Rash is present in less than 10% of patients 1

Risk Factors for Severe Anaplasmosis

Certain factors increase the risk of severe anaplasmosis:

• Advanced patient age (relevant to this 61-year-old patient) 1
• Immunosuppression (potentially relevant due to prednisone therapy) 1
• Comorbid medical conditions 1
• Delay in diagnosis and treatment 1

Adrenal Hyperplasia and Prednisone Therapy Considerations

For patients with adrenal hyperplasia on corticosteroid therapy:

• Patients on chronic corticosteroid therapy have suppression of the hypothalamo-pituitary-adrenal axis 1
• During acute illness like anaplasmosis, these patients require stress dosing of corticosteroids to prevent adrenal crisis 1
• Low-dose prednisone treatment for adrenal hyperplasia is generally safe and effective for maintaining normal physiologic function 2

Febrile Seizures: Age-Specific Condition

Febrile seizures have specific characteristics that make them unlikely in this case:

• By definition, febrile seizures occur in children between 6-60 months of age 1
• They affect approximately 2-5% of children in this age group 1
• Febrile seizures do not typically occur in adults 1

Relationship Between Adrenal Disorders and Seizures

While there are limited studies on adrenal disorders and seizures:

• Some case reports suggest seizures in children with congenital adrenal hyperplasia may be related to metabolic disturbances like hypoglycemia or hyponatremia, or possibly to excess corticotropin-releasing factor 3
• One study of 22 children with congenital adrenal hyperplasia found that 8 had seizures associated with fever, but none had seizures after 5 years of age 3
• There is no evidence in the literature suggesting that adults with adrenal hyperplasia are at increased risk for febrile seizures 3, 4

Management Recommendations for This Patient

If this patient contracts anaplasmosis:

• Increase corticosteroid dosing according to stress dosing protocols (typically 2-3 times maintenance dose) 1
• Monitor for signs of adrenal crisis including hypotension, nausea, vomiting, and confusion 1
• Treat anaplasmosis promptly with doxycycline to prevent complications 1
• Monitor for laboratory abnormalities commonly seen in anaplasmosis: thrombocytopenia, leukopenia, elevated hepatic transaminases, and mild anemia 1

Important Caveats and Considerations

• While febrile seizures are not a concern in this adult patient, the combination of advanced age and corticosteroid use does place him at higher risk for severe anaplasmosis 1
• Ensure adequate hydration and electrolyte balance during the illness 1
• Consider hospitalization if the patient develops severe symptoms, as approximately 7% of hospitalized anaplasmosis patients require intensive care 1
• Be vigilant for opportunistic infections, which have been reported during anaplasmosis infection, particularly in immunosuppressed patients 1