Recurrent Aseptic Meningitis Research Articles

Unravelling Kikuchi-Fujimoto Disease: A Unique Presentation of Recurrent Aseptic Meningitis in a District Hospital Setting

Unravelling Kikuchi-Fujimoto Disease: A Unique Presentation of Recurrent Aseptic Meningitis in a District Hospital Setting

Rathke's cleft cyst presenting with recurrent aseptic meningitis and inflammatory apoplexy: illustrative case.

Rathke's cleft cyst (RCC) is a benign sellar/suprasellar lesion often discovered incidentally. Rarely, symptomatic cases can present with headache and may exhibit concomitant aseptic meningitis or apoplexy. The authors describe a patient with an RCC presenting with recurring episodes of aseptic meningitis and ultimately inflammatory-type apoplexy. A 30-year-old female presented with three episodes of intractable headaches over 2 months. Each episode's clinical picture was consistent with meningitis though cerebrospinal fluid cultures, and viral tests remained negative. Imaging demonstrated a sellar lesion, initially thought to be coincidental. On the third presentation, there was rapid interval growth of the lesion, adjacent cerebritis, and new endocrinopathy. Resection was then performed via an endoscopic endonasal approach. Pathology showed an RCC with acute and chronic inflammation and no evidence of hemorrhage. Cultures were negative for organisms. The patient received several weeks of antibiotic treatment with the resolution of all symptoms and no recurrence. Recurrent aseptic meningitis with apoplexy-like symptoms is a rare presentation of RCC. The authors propose the term inflammatory apoplexy to describe such a presentation without evidence of abscess, necrosis, or hemorrhage. The mechanism is unclear although may be due to intermittent microleakage of cyst contents into the subarachnoid space.

Primary Sjogren’s syndrome presents as recurrent meningoencephalitis

Primary Sjogren’s syndrome is an autoimmune disease mostly affecting middle-aged females. It usually involves the exocrine glands system resulting in dryness of the mouth and eyes. It rarely involves the Central nervous system. Here we present a case of Sjogren’s syndrome with a rare presentation at an unusual age. An 80 years old patient who presented with 3 episodes of recurrent aseptic meningitis in a year, was diagnosed with primary Sjogren’s syndrome after extensive workup. She responded well to immunomodulatory treatment. Clinicians should consider the rare presentation and age of autoimmune diseases when facing the challenging clinical situation.

Surgical Presets of Ruptured Dermoid Cyst Resection: 2-Dimensional Operative Video.

Intracranial dermoid cyst is a benign expansive lesion typically affecting children and young adults. They become symptomatic by progressive enlargement of the cyst and spilling of its content. In such cases, recurrent aseptic meningitis is observed. When located in the suprasellar area, optic pathways are usually displaced and compressed, and visual symptoms are common, as well as seizures. The tumor capsule can be thick and very adherent to the anterior cerebral arteries and the small arterial perforators. Radical surgical resection, including the capsule, is the current mainstay of treatment.1-5 The cranio-orbital approach is considered as an excellent surgical access option. Vascular adhesions are associated with a considerable surgical risk to the circle of Willis and its small branches. Residual cyst or perioperative spilling of its content produces severe aseptic meningitis and vasospasm associated with postoperative complications and long-term recurrences.4 This article demonstrates the details of the surgical management of a ruptured suprasellar dermoid cyst in a 22-year-old man. The patient consented to the procedure and publication of images. Image at 2:23 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas, Vol 1, ©LWW, 1998. Illustration at 2:47 reprinted from Surgical Neurology, 50(6), Arnautovic et al, "A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms," p 17, ©1998, with permission from Elsevier.

Abstracts from the ISSAID 2021 Periodic Congress

Abstracts from the ISSAID 2021 Periodic Congress

A case report of benign recurrent aseptic meningitis and literature review

Abstract Benign recurrent meningitis, also known as Mollaret’s meningitis (MM), is characterized by recurrent headache, fever, meningeal irritation and sterility of cerebrospinal fluid examination, which is rare in clinic. Although with clear diagnostic criteria, there are still many unclear aspects of its pathogenesis, and treatment of this disease. The author reported a case of benign recurrent aseptic meningitis, who had three episodes of acute headache with or without fever. The patient was treated with ceftriaxone, acyclovir and cefazoxime for the first time, cefazoxime, cefimidazole and mebendazole for the second time, and piperacillin and acyclovir for the third time. The results showed that the patient did not recover completely in the first two times and fully recovered at the third time. Based on the current research, the author believes that for MM, mainly symptomatic relief, indomethacin should be recommended, and too much antiviral treatment is not needed.

Клінічний випадок поєднання вторинного головного болю з рецидивуючими генітальними висипаннями в iмунокомпетентної жінки

У статті наведено детальний аналіз клінічного випадку рецидивуючих епізодів вираженого головного болю з появою висипання в ділянці зовнішніх статевих органів у імунокомпетентної жінки. Описано особливості перебігу цiєї патології, наведено результати лабораторного обстеження з обґрунтуванням вибору методів і оцінкою ефективності терапії. Наведено аналіз і класифікацію можливих інфекційних та неінфекційних етіологічних причин головного болю відповідно до Міжнародного товариства головного болю. Подано історичну довідку про менінгіт Молларе, діагностичні критерії цього діагнозу, описано терапію і прогноз. Також проведено диференціальну діагностику інших причин доброякісного рецидивуючого асептичного менінгіту. У результаті диференціального підходу в наведеному клінічному випадку був діагностований менінгіт Молларе. У статті описано особ­ливості цієї патології і діагностичні критерії, обговорено можливі етіологічні причини і схеми терапії. Підкреслено необхідність і ефективність тривалої супресивної хіміотерапії для профілактики повторних епізодів клінічного загострення в терапії менінгіту Молларе.

Méningite récidivante révélant un syndrome de Bing-Neel

IntroductionBing-Neel syndrome is a rare complication of Waldenström macroglobulinemia, defined by monoclonal lymphoplasmocytic cells in the cerebrospinal fluid or in central nervous system biopsy. Case reportWe report a 47-year-old man, with no prior history, who presented a recurrent aseptic lymphocytic meningitis with central nervous manifestations. The presence of a monoclonal lymphoplasmacytic proliferation in cerebrospinal fluid, blood and bone marrow biopsy results was compatible with a diagnosis of Bing-Neel syndrome. Despite the absence of any specific treatment, there was no recurrence of symptoms at 4-month follow-up, and the MRI lesions remained stable. ConclusionWe report a case of Bing-Neel syndrome revealed by a recurrent meningitis. Outcome without treatment was favorable at 4-month follow-up.

Recurrent stroke and aseptic meningitis in patient with Fabry disease: A case report

Fabry Disease (FD) is a rare, potentially curable, hereditary disease. Despite of enzyme replacement therapy (ERT) recurrent stroke and aseptic meningitidis are developed. The 26 year-old male was diagnosed FD after the first ischemic stroke. In a 6 months of receiving ERT the second ischemic stroke in the vertebrobasilar system was developed. In a month severe headache with nausea, vomiting and paresis of the right oculomotor nerve developed, without lesions on MRI. The cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis of 24/μL. Aseptic meningitis was diagnosed. Prednisolone 50 mg a day was prescribed. After treatment with glucocorticoids, oculomotor disturbances and cerebral symptoms regressed over a 3 day. In a month the third ischemic stroke developed in the patient in the vertebrobasilar system with headache and dysarthria. He had stopped to take prednisolone by this time. After this stroke headache increased, and the patient started taking nonsteroid anti-inflammatory drugs without permanent effect. The cognitive impairment progressed. Despite of normal CSF analysis prednisolone 10 mg once a day was administered. Headache regressed next day after starting this treatment. During the treatment with prednisolone the patient demonstrated cognitive improvement. When we tried to decrease the dose of prednisolone the patent had a deterioration with his oculomotor nerves without lesion on the MRI Activation of immune system in some patients with FD could lead to autoinflammation in the central nervous system, as a result – aseptic meningitidis. Prednisolone administration in spite of recurrent stroke could improve outcome in such patients.

Familial Mediterranean Fever Is Important in the Differential Diagnosis of Recurrent Aseptic Meningitis in Japan

Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by a recurrent fever and multiple serositis. In the present report, we discuss the case of a 42-year-old man diagnosed with FMF accompanied by recurrent aseptic meningitis (RAM). The patient experienced RAM at intervals of several years without any serositis or synovitis. We detected Mediterranean fever (MEFV) gene mutations (E148Q homozygotes) and diagnosed FMF in perfect accordance with clinical diagnostic criteria. FMF, in which RAM is a major symptom, has also been described in previous reports. Therefore, FMF should be considered in the differential diagnosis of causative diseases for RAM.

Recurrent aseptic meningitis as an initial clinical presentation of primary Sjögren’s syndrome

Recurrent aseptic meningitis as an initial clinical presentation of primary Sjögren’s syndrome

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.

Complement factor I deficiency with recurrent aseptic meningitis in child and literature review

目的 总结补体Ⅰ因子(CFI)缺陷伴反复无菌性脑膜炎的临床表现、实验室检查、基因特点及治疗措施，并进行文献复习。 方法 回顾性分析2016年7月至2017年2月在重庆医科大学附属儿童医院神经内科收治的1例补体Ⅰ因子缺陷伴反复无菌性脑膜炎患儿的临床资料，结合文献分析CFI缺陷伴反复无菌性脑膜炎的实验室检查、基因特点及诊治进展，应用PubMed、Medline医学数据库检索，以complement factor I AND meningitisorcomplete factor I deficiency为关键词，并对检索出的文献病例资料进行总结。 结果 本例患儿因7个月内反复发热、头痛7次住院，基因检测结果提示CFI基因纯合突变(c.772＋1G>T)，为错义突变，确诊CFI缺陷伴反复无菌性脑膜炎，每次发病均给予抗生素及甘露醇治疗后好转，但均不能预防下次无菌性脑膜炎发作。检索国内外文献，以补体Ⅰ因子和脑膜炎为关键词，未检索到中文文献。 结论 CFI缺陷伴反复无菌性脑膜炎可继发于CFI基因突变、血清CFI缺乏或功能缺失，以反复发作无菌性脑膜炎为主要特征，血清CFI水平测定、功能测定及基因检测有助于诊断，目前以对症治疗为主，尚无根治治疗，一般不遗留神经系统后遗症。

A Case of Mollarets Meningitis In Apollo Hospitals Dhaka

Mollarets Meningitis is defined as a benign recurrent aseptic meningitis characterized by more than three episodes of fever, headache, meningeal irritation lasting typically 3-5 days. It has spontaneous recovery without any residual neurological deficit. Mollaret in 1944 described this extremely rare form of self-limiting aseptic recurrent benign meningitis. Here we present the report of a patient with Mollarets Meningitis with some atypical features. Early diagnosis may prevent prolonged hospital admissions, unnecessary investigations, and exposure to unnecessary medications, with their associated considerable costs.Pulse Vol.10 January-December 2017 p.42-46

Atypical type of familial Mediterranean fever: An underdiagnosed cause of chronic aseptic meningitis.

We report an atypical case of familial Mediterranean fever (FMF) concomitant with chronic aseptic meningitis. The patient experienced fever, abdominal and back pain because of serositis, and headache because of aseptic meningitis for 4 weeks. Blood examinations revealed increased white blood cells and serum amyloid A level. Medications, including steroids, did not improve his symptoms. However, the patient experienced immediate relief after the administration of colchicine. We diagnosed him as having atypical FMF based on the symptoms, especially positive response to colchicine, and heterozygous mutations on exon2 and 5 (E148Q/S503C) in MEFV gene. Unlike typical FMF, a cause of recurrent aseptic meningitis, atypical FMF might be an underdiagnosed cause of chronic aseptic meningitis.

Recurrent Aseptic Basal Meningitis as the First Clinical Manifestation of a Sjogren Syndrome in a Patient with an Overlap Syndrome with Familial Mediterranean Fever

Recurrent Aseptic Basal Meningitis as the First Clinical Manifestation of a Sjogren Syndrome in a Patient with an Overlap Syndrome with Familial Mediterranean Fever

Meningite de Mollaret

Introdução: Meningite de Mollaret consiste em uma forma de meningite asséptica, sendo considerada uma patologia rara, haja visto a revisão literária mundial apresentar aproximadamente 50 casos descritos até o momento. Objetivo: Descrição de caso de meningite asséptica decorrente de lesão expansiva epidermóide. Método: Mulher submetida à ressecção retrossigmoidéia de tumor epidermóide em ângulo ponto-cerebelar a direita evoluindo sem déficits no pós-operatório imediato, mas evoluindo, no pós-operatório tardio, com meningismo e deficit de nervos cranianos contralaterais à lesão primária. Exames de propedêutica liquórica evidenciaram meningite sem crescimento de microorganismos. Discussão: A cascatainflamatória sistêmica desencadeada por essa patologia pode gerar um estado toxêmico, assemelhando-se clinicamente a meningite bacteriana. O estudo liquórico não evidencia agente causador, a despeito da elevação de polimorfonucleares e a redução da glicorraquia. O risco de desenvolver meningite asséptica pode ser reduzido, evitando-se contaminação do conteúdo cístico no espaço subaracnóide, removendo cuidadosamente todo tecido cístico e administrando corticoterapia no perioperatório. Conclusão: Meningite asséptica é uma patologia rara, sem consenso a respeito de seu manejo, justificando a necessidade de acúmulo de conhecimentos a partirde relatos de casos em todo o mundo

Kystes dermoïdes de la fosse cérébrale postérieure chez l’enfant révélés par des méningites aseptiques récidivantes : à propos de deux cas et revue de la littérature

IntroductionDermoid cysts of central nervous system are very rare. The usual clinical presentation is dominated by intracranial hypertension, epilepsy and cranial palsy. The revelation mode could be recurrent aseptic meningitis. AimThe aim of this case report is to consider the dermoid cyst as regards the differential diagnosis in children treated for recurrent aseptic meningitis to avoid misdiagnosis and ice qui a orienté le diagnostic à une méningitnadequate treatment. MethodsTwo children were admitted in the pediatric department for recurrent aseptic meningitis. The MRI confirmed the presence of a posterior fossa dermoid cyst. ResultsLoss of meningitis after microsurgical resection. ConclusionThe diagnosis of dermoid cyst is performed and reconsidered at an early stage in aseptic meningitis in order to establish an adequate therapy, which is surgery.

Clinical commentary on ‘Recurrent natalizumab-related aseptic meningitis in a patient with multiple sclerosis’, by Foley et al.

This clinical commentary discusses the occurrence of drug-induced aseptic meningitis in patients undergoing natalizumab treatment and other immunotherapies.

Recurrent Meningitis.

Recurrent meningitis is a rare clinical scenario that can be self-limiting or life threatening depending on the underlying etiology. This review describes the causes, risk factors, treatment, and prognosis for recurrent meningitis. As a general overview of a broad topic, the aim of this review is to provide clinicians with a comprehensive differential diagnosis to aide in the evaluation and management of a patient with recurrent meningitis. New developments related to understanding the pathophysiology of recurrent meningitis are as scarce as studies evaluating the treatment and prevention of this rare disorder. A trial evaluating oral valacyclovir suppression after HSV-2 meningitis did not demonstrate a benefit in preventing recurrences. The data on prophylactic antibiotics after basilar skull fractures do not support their use. Intrathecal trastuzumab has shown promise in treating leptomeningeal carcinomatosis from HER-2 positive breast cancer. Monoclonal antibodies used to treat cancer and autoimmune diseases are new potential causes of drug-induced aseptic meningitis. Despite their potential for causing recurrent meningitis, the clinical entities reviewed herein are not frequently discussed together given that they are a heterogeneous collection of unrelated, rare diseases. Epidemiologic data on recurrent meningitis are lacking. The syndrome of recurrent benign lymphocytic meningitis described by Mollaret in 1944 was later found to be closely related to HSV-2 reactivation, but HSV-2 is by no means the only etiology of recurrent aseptic meningitis. While the mainstay of treatment for recurrent meningitis is supportive care, it is paramount to ensure that reversible and treatable causes have been addressed for further prevention.