A Recipe for Delirium: Community-Acquired Pneumonia and Sickle Cell Anemia With Moyamoya Disease

Moyamoya disease (MMD) is a rare, progressive cerebrovascular disorder that occurs when the major arteries supplying the brain become narrowed or obstructed. Because of this, small and delicate collateral vessels develop to compensate for the decrease in blood flow. Unfortunately, these vessels are insufficient to meet the brain’s metabolic demands. Though initially described in Japan, MMD occurs in a variety of ethnicities around the world. The clinical manifestations of the disease can be devastating, with patients often presenting with symptoms of a stroke or transient ischemic attack. The long history of insults and chronic changes to the brain makes these individuals susceptible to alterations in their mental status. We describe a case of a young African American female with a history of sickle cell anemia (SCA) and undiagnosed MMD who presented to the emergency department with community-acquired pneumonia (CAP). In addition to her medical derangements, she also presented with paranoia, delusional guilt, and refusal to speak.