Episodes Of Aseptic Meningitis Research Articles

Aseptic meningitis and Fabry disease.

Fabry disease is caused by enzymatic defects in alpha-galactosidase A that leads to the accumulation of glycosphingolipids throughout the body, resulting in a multisystemic disorder. The most common neurological manifestations are neuropathic pain, autonomic nervous system dysfunction and strokes, but some rarer neurological manifestations exist. Among these, aseptic meningitis is a possible complication. Our objectives were to measure the prevalence of this complication in a cohort of patients with Fabry disease, and to describe its clinical features. We conducted a retrospective review of Fabry disease patients followed at our tertiary referral center between 1995 and September 2023 with at least one episode of meningitis, and performed a systematic review to identify similar published cases. Four patients out of 107 (3.7%) had at least one episode of aseptic meningitis. Our systematic review identified 25 other observations. The median age of these 29 patients was 29.0 years, the median cerebrospinal fluid leukocyte count was 24 cells/mm3 with a predominance of lymphocytes in 64.7% of cases. In 82.8% of the patients, the diagnosis of Fabry disease was unknown before the meningitis. Large artery stenosis was present in 17.2% of patients and 57.1% of patients had a recent stroke concomitant with the meningitis. Several differential diagnoses were evoked, such as multiple sclerosis or central nervous system vasculitis. Our study suggests that Fabry disease should be considered as a cause of aseptic meningitis. The pathophysiological mechanisms underlying meningeal inflammation remain largely unknown but may reflect the dysregulation of pro-inflammatory signaling pathways.

P051 Juvenile Behcet's disease

Abstract Background Behçet's disease is a rare systemic vasculitis in children. The most frequent manifestations are orogenitalaphthosis and uveitis. Neurological, digestive, vascular, joint, and skin involvement are possible. We aimed to describe the clinical, diagnostic criteria, and therapeutic features of pediatric-onset Behcet's disease Methods Study carried out based on files collected over 12 years (2007–2018) concerning patients under the age of 15 hospitalized in the pediatric department of CHU de Blida for Behcet disease Results For 12 years (2007–2018), we hospitalized five children for various reasons and whose diagnosis of Behcet's disease was retained. These are 03 boys (2 of the theme are brothers) and 02 girls. The average age at admission was 13.5 years (12–15 years), and the average duration of follow-up is 4.2 years (15 months-8 years). The mean age of onset of first symptoms was 11 years, and the meantime to diagnosis was 2 years (12 months-3 years) The main diagnostic criteria were: mouth ulcers in five patients (100%), genital ulcers in three patients (60%), ophthalmic manifestations in two patients (40%): one had bilateral uveitis, and the other had papillitis, the pathergy test was positive in 3 patients (60%). The other manifestations were as follows: polyarthralgia in 3 patients (60%), family history in one patient (20%). Neurological manifestations were present in 3 patients (60%): one child presented two episodes of aseptic meningitis and thrombosis deep cerebral venous; one child with diffuse cerebral demyelination lesions, and the third with HIC syndrome and massive lateral sinus thrombosis. Three children have a vascular involvement (60%): pulmonary embolism with thrombosis of the superior vena cava (20%), bilateral thrombosis of the jugular veins (20%), and thrombosis of the right ventricle complicated by pulmonary embolism (20%) Initial symptoms included recurrent aphthous stomatitis (100%), arthralgia (60%), prolonged fever (20%), behavioral disturbances and dysarthria (20%), weight loss (40%), and headache (60 %). The histocompatibility antigen (HLAB 51) was found in 2 children (40%). The treatment included corticosteroids for all patients (3 boluses of 1 g/m2/day of methylprednisolone then relayed by prednisone 1 mg/kg/day), azathioprine 2.5 mg/kg/day in 5 children (100%), and colchicine for 2 patients only one patient had received anticoagulant therapy (LMWH followed by VKA) Relapses were observed in a single patient (20%) and mortality in one patient (20%.) Conclusion Behcet's disease is a rare disease whose diagnosis remains difficult in children. However, early diagnosis and aggressive treatment are mandatory to avoid complications and functional sequelae.

Випадок доброякісного рецидивуючого асептичного менінгіту Молларе, що викликаний вірусом простого герпесу (HSV 1/2), у 9-річної дитини

Доброякісний рецидивуючий менінгіт Молларе — рідкісне захворювання, що характеризується повторними епізодами асептичного менінгіту зі спонтанним одужанням. Аналіз опублікованих випадків менінгіту Молларе свідчить, що захворювання переважно зустрічається в дорослих. Існують лише поодинокі повідомлення про захворювання в дітей. У даній статті наведений клінічний випадок менінгіту Молларе у хворої, у якої спостерігалося 5 епізодів захворювання, починаючи з 3-річного віку.

Recurrent aseptic meningitis- a rare clinical presentation of Sjogrens syndrome

Sjogren's syndrome most commonly presents with dry eyes, dry mouth, joint pain and fatigue. However, recurrent aseptic meningitis, reported as the most uncommon initial symptom, was the presenting feature in our case. We present the case of a 19-year-old female with recurrent episodes of aseptic meningitis. She presented with fever, headache, vomiting and photophobia. Neurological examination showed neck stiffness. Fundoscopy was normal. On two previous occasions her cerebrospinal fluid analysis was consistent with meningitis; however, it was normal at this presentation. Review of system revealed history of fatigue and sicca symptoms since early childhood. Autoimmune workup showed antinuclear antibodies with a titer of 1:400 and positive anti SSA (Ro) antibodies that led to the diagnosis of Sjogren's syndrome. She responded well to intravenous steroids, followed by oral prednisolone and hydroxychloroquine. To conclude, diagnosis of Sjogren's syndrome may also be considered in a patient presenting with recurrent aseptic meningitis.

Mollaret Meningitis with High Level of Cytokines in CSF Successfully Treated by Indomethacin

A rare case of Mollaret meningitis characterized by four recurrent episodes of aseptic meningitis during the 3-year periods were reported. The patient showed high fever and severe headache accompanied by high level of cerebrospinal fluid (CSF) cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alfa (TNF-a). The symptoms and high CSF cytokines were dramatically resolved immediately after inducing indomethacin treatment. Reactivation of the latent virus is considered to be the cause of this rare disease and indomethacin is estimated to inhibit periodic abnormal generation of eicosanoid in the brain resulting in reducing fever and subsequent inflammation.

Sulphasalazine-induced aseptic meningitis with facial and nuchal edema in a patient with spondyloarthritis

Sulphasalazine-induced aseptic meningitis with facial and nuchal edema in a patient with spondyloarthritis

Lifelong urticaria and multiple unexplained systemic symptoms

Conflict of interest: none declared. A 23‐year‐old man had a history of a recurrent, urticated, mildly itchy eruption since infancy, of myalgia and headaches since childhood, and an episode of aseptic meningitis at 14 years of age. Other symptoms included mouth and genital ulceration, sensorineural deafness, and conjunctivitis. Sudden onset of visual blurring led to admission for neurological investigation. On physical examination, an urticarial eruption was seen on the trunk and arms (Fig. 1), with mild muscle weakness and bilateral papillo‐oedema (Fig. 1). Erythrocyte sedimentation rate and C‐reactive protein were raised (50 mm/h and 47 mg/L; normal ranges 0–15 mm/h and < 10 mg/L, respectively). Cerebrospinal fluid (CSF) examination was abnormal, with a raised white cell count (41 × 106/L and 60% polymorphs; normal 0–5 × 106/L and no neutrophils), raised protein (0.7 g/L; normal 0.2–0.4 g/L) and increased CSF opening pressure. Nerve conduction studies, electromyography, and brain magnetic resonance imaging gave normal results.

Mollaret meningitis: case report with a familial association

Mollaret meningitis is a syndrome characterized by recurrent bouts of meningitis that occur over a period of several years in an affected patient. Also known as recurrent lymphocytic meningitis, this entity involves repeated episodes of headache, stiff neck, fever, and cerebrospinal fluid pleocytosis. Herpes simplex virus type 2 is the most frequently implicated causative agent, and treatment involves the use of antiviral medications. We describe a case of Mollaret meningitis in a 47-year-old man who presented to the emergency department with his eighth episode of meningitis during a period of 20 years. Cerebrospinal fluid polymerase chain reaction testing for herpes simplex virus type 2 was positive, and further testing excluded other common viral, bacterial, and inflammatory causes of meningeal irritation. The patient's family history was significant for a brother who also had multiple episodes of aseptic meningitis during a period of several years. This represents the first published report of a possible familial association involving Mollaret meningitis. It is likely that Mollaret meningitis is underrecognized among emergency physicians, and improved recognition of this entity may limit unwarranted antibiotic use and shorten or eliminate unnecessary hospital admission.

Recurrent Meningitis Attributable to Herpes Simplex Virus-2 in a Child

A boy manifested episodes of recurrent meningitis that were attributed to herpes simplex virus-2 infection. He presented no concurrent or previous history of involvement of the genitourinary system. He exhibited headaches, dizziness, photophobia, loss of balance, and vomiting. He underwent three episodes of aseptic meningitis. The herpes simplex virus-2 etiology was confirmed by polymerase chain reaction of the cerebrospinal fluid in the last two episodes. After the third occurrence, he was treated with acyclovir. Five years have elapsed since then, without the recurrence of aseptic meningitis.

Metronidazole-Induced Aseptic Meningitis during Helicobacter pylori Eradication Therapy

Letters6 March 2007Metronidazole-Induced Aseptic Meningitis during Helicobacter pylori Eradication TherapySujoy Khan, MBBS, Basil Sharrack, MD, PhD, and W.A.C. Sewell, MBBS, PhDSujoy Khan, MBBSFrom Scunthorpe General Hospital, Scunthorpe, United Kingdom; Lincoln County Hospital, Lincoln, United Kingdom; and University of Lincoln, Brayford Pool, Lincoln, United Kingdom.Search for more papers by this author, Basil Sharrack, MD, PhDFrom Scunthorpe General Hospital, Scunthorpe, United Kingdom; Lincoln County Hospital, Lincoln, United Kingdom; and University of Lincoln, Brayford Pool, Lincoln, United Kingdom.Search for more papers by this author, and W.A.C. Sewell, MBBS, PhDFrom Scunthorpe General Hospital, Scunthorpe, United Kingdom; Lincoln County Hospital, Lincoln, United Kingdom; and University of Lincoln, Brayford Pool, Lincoln, United Kingdom.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-5-200703060-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Drugs can cause symptomatic meningitis with cerebrospinal fluid (CSF) abnormalities, such as neutrophilic pleocytosis, and increased CSF protein that mimic infection. Nonsteroidal anti-inflammatory drugs (NSAIDs) and antimicrobials are the most common causes of drug-induced aseptic meningitis.Objective: To report a case of a patient who had 3 episodes of aseptic meningitis during eradication therapy for Helicobacter pylori infection.Case Report: A 42-year-old man was admitted in July 2004, reporting headache, nausea, photophobia, and neck stiffness within 2 hours of taking lansoprazole (30 mg), amoxicillin (1 g), and metronidazole (400 mg) combination therapy. He had been diagnosed with viral meningitis ...

Metastatic Chondroblastoma With Elevated Creatine Kinase and Paraneoplastic Neurologic Autoimmunity

A 17-year-old girl presented with chondroblastoma of the fibula and pulmonary metastases. Serum creatine kinase (CK) was elevated for a decade preoperatively and fell to near normal after tumor excision. An episode of aseptic meningitis 3 months later led to serologic detection of three antibody markers of paraneoplastic neurologic autoimmunity that in adult patients are characteristic of thymoma and lung carcinoma: muscle-type acetylcholine receptor (AChR) autoantibody (Ab), type 2 Purkinje cell cytoplasmic Ab (PCA-2), and collapsin response-mediator protein-5-IgG (CRMP-5-IgG). Locally recurrent chondroblastoma was excised 1 year later. Serum CK was elevated, CRMP-5-IgG was positive, PCA-2 was lower, and AChR Ab was undetectable. Three years after diagnosis she has stable pulmonary metastases, with elevated CK, higher PCA-2, positive CRMP-5-IgG, and undetectable AChR Ab. The association of metastatic chondroblastoma, elevated CK, and an evolving profile of paraneoplastic autoantibodies reveals a previously unrecognized immunobiologic dimension of chondroblastoma.

Quistes dermoides y epidermoides intracraneales

Dermoid and epidermoid cysts are dysembryogenic tumors representing 1% of all intracranial tumors. They are characterized by slow growth, localization to the middle in relation to the basal cisterns and their benign course. To analyze the clinical and radiological characteristics, and the results of surgical treatment of intracranial dermoid and epidermoid cysts. We reviewed 18 cases of epidermoid and 3 dermoid intracranial cysts which had been diagnosed and treated during a period of 18 years. All patients were diagnosed by computerized tomography (CT) and the last 15 cases by magnetic resonance (MR). The commonest site was the temporal lobe with 7 cases, followed by the suprasellar region with 4 cases. All patients had peculiar imaging characteristics both on CT (hypodense and with no contrast silhouetted) and on MR (hypointensity in T1 and in T2). They were completely resected in 16 cases. There were 3 episodes of aseptic meningitis and 2 deaths. Dermoid and epidermoid cysts are characterized by long term clinical symptoms. The commonest site is supratentorial in the midline or in the temporosylvian region. The diagnostic investigation of choice is MR. Treatment is surgical, preferably complete resection. However, after sub-total resection there is a prolonged period of remission.

Reply from the Authors

Reply from the Authors: We appreciate the comments offered by Ikeda et al. to our article concerning factors hampering diagnosis of neuro-Behcet's disease. In response to their question concerning the temporal relationship between neurologic and ophthalmologic disease, only one of our patients had documented active ocular involvement at the time of active neurologic disease (this patient had active uveitis during an episode of aseptic meningitis). A second patient had an acute flare of uveitis on ocular examination 20 …

Trimethoprim-Induced Aseptic Meningitis in a Patient with AIDS: Case Report and Review

We report the case of a 41-year-old man infected with human immunodeficiency virus who had two episodes of aseptic meningitis that occurred 2 weeks apart; the first was associated with ingestion of trimethoprim-sulfamethoxazole (TMP-SMZ) and the second was associated with ingestion of TMP alone. Onset of fever, headache, and flushing was abrupt, followed by somnolence, hearing loss, and aphasia. Analysis of the CSF showed pleocytosis and an elevated protein level. The findings resolved within 48 hours after withdrawal of the drug. We also review 18 previously reported cases of TMP-SMZ- or TMP-induced meningitis, 17 of which occurred in women. In all of these cases, a similar abrupt onset and resolution were noted. Six of the 18 patients had collagen-vascular diseases. All but two of these patients had multiple recurrent episodes of meningitis before the diagnosis was made. We conclude that the diagnosis of TMP-SMZ- or TMP-induced meningitis should be considered when a patient receiving these drugs has recurrent episodes of aseptic meningitis.

Neurologic manifestations in familial Mediterranean fever

Neurologic involvement in children with familial Mediterranean fever is relatively uncommon and rarely described in the pediatric literature. Although headaches occur frequently, meningitis and convulsions are rare. Thirteen of 101 children with familial Mediterranean fever developed neurologic manifestations. Of these 13 patients, 10 had headaches during acute episodes of the fever. Two patients had convulsions with fever before the age of 5 years; the convulsions and acute episodes recurred at ages 9 and 10 years. Another patient had two episodes of aseptic meningitis followed by convulsive disorder before the diagnosis of familial Mediterranean fever was made; his convulsions were resistant to antiepileptic drugs alone and subsided only when colchicine was added. The possibility of neurologic involvement should be considered in patients with familial Mediterranean fever.

TRIMETHOPRIM-INDUCED ASEPTIC MENINGITIS

ASEPTIC meningitis has been described in association with the administration of anti-inflammatory drugs, including ibuprofen, sulindac and tolmetin sodium, and azathioprine.1-4Most, but not all, of the patients reported have had either systemic lupus erythematosus (SLE) or mixed connective-tissue disease.5,6Sulfamethizole-induced meningitis and pancreatitis have been described in a patient who was ostensibly free of underlying chronic disease.7More recently, aseptic meningitis has been associated with the use of trimethoprim-sulfamethoxazole.8This report describes a patient with Sjogren's syndrome who had four episodes of aseptic meningitis temporally related to the use of trimethoprim-sulfamethoxazole, and a single episode of aseptic meningitis following the use of trimethoprim alone. Report of a Case First Admission.— A 61-year-old diabetic woman was hospitalized in June 1979 with a two-day history of fever, headache, nausea, and myalgias. Three years previously, she had complained of hair loss, arthralgias, and dryness of the eyes and

1118 CHRONIC-REACTIVATION EBSTEIN-BAR VIRUS (EBV) INFECTION PRESENTING AS RECURRENT ASEPTIC MENINGITIS

A wide spectrum of chronic-reactivation infections due to EBV has been documented in patients with or without primary immunodeficiencies. Recently, we found evidence suggesting EBV as the cause of recurrent aseptic meningitis. This male child presented several years beforehand with recurrent urticaria, arthralgias, chronic papillitis, neurosensory hearing loss, and 5 episodes of aseptic meningitis (last episode at 13.2 yr.). CSF during acute episodes contained up to 1×104 leukocytes/mm3 (principally neutrophils), elevated proteins (70-250mg/dl), but no microorganisms. B and T cell functions appeared normal. Serum antibodies to EBV were: In addition, CSF contained IgG antibodies (1:5) to the capsid antigen. Thus, the chronic-recurrent central nervous system abnormalities may be due to EBV. EBV genes and antigens in the child's cells and immune response of the patient to EBV are being investigated.

Enteroviral meningitis in early infancy: significance in community outbreaks.

Sixty-eight episodes of aseptic meningitis were diagnosed in 67 children during summer-fall 1979. Enteroviruses were isolated from 38 (79%) of 48 cases (47 children) with viral isolation studies performed. In 27 cases the enterovirus was isolated from the cerebrospinal fluid. Except for one Coxsackie B-4 and one Coxsackie B-5 virus infection, all of the enteroviruses isolated were echoviruses; no single echovirus type predominated. The ages of the children with aseptic meningitis associated with an enteroviral infection ranged from 3 weeks to 14 years, with 79% of patients being under 1 year old. Forty-seven percent were infants less than 4 months old. Mild hypoglycorrhachia defined as a cerebrospinal fluid: blood sugar ratio of less than 0.50 may be a common finding in enteroviral meningitis in very young children.

Mollaret's meningitis and differential diagnosis of recurrent meningitis: Report of case, with review of the literature

The clinical features in a patient with recurrent brief episodes of aseptic meningitis are described. They were identical to those in an entity known as Mollaret's meningitis and ours is the first recorded instance of this disease in the United States. Large fragile “endothelial” cells were observed in the cerebrospinal fluid as well as a mild degree of hypoglycorrhachia and a mild increase in gamma globulins. There was a tendency toward leukopenia and mild eosinophilia during the symptom-free intervals. There was also a modest increase in the concentration of immunoglobulin M (IgM) in the serum. The data in nineteen previously recorded cases of Mollaret's meningitis are reviewed, and the occurrence of transient neurologic manifestations in some of them is stressed. These include coma, grand mal seizures, syncope, delirium, hallucinations, anisocoria, absence of abdominal reflexes, visual disturbances, diplopia, speech impairment, disequilibrium, facial paresis and unilateral or bilateral Babinski reflexes. However, in patients with Mollaret's disease most episodes are characterized by a mild meningitis without any associated additional neurologic abnormalities. Conditions which should be considered in differential diagnosis of recurrent meningitis or low grade fluctuating encephalomeningitis or meningitis are discussed. It is our opinion that, although at times there may be difficulties in differentiating it from other conditions, Mollaret's meningitis is a distinct, albeit rare, clinical entity.