Confirmed viral meningitis with normal CSF findings
Abstract
An 18-year-old woman presented with a progressively worsening headache, photophobia feverishness and vomiting. Three weeks previously she had returned to the UK from a trip to Peru. At presentation, she had clinical signs of meningism. On admission, blood tests showed a mild lymphopenia, with a normal C reactive protein and white cell count. Chest X-ray and CT of the head were normal. Cerebrospinal fluid (CSF) microscopy was normal. CSF protein and glucose were in the normal range. MRI of the head and cerebral angiography were also normal. Subsequent molecular testing of CSF detected enterovirus RNA by reverse transcriptase PCR. The patient's clinical syndrome correlated with her virological diagnosis and no other cause of her symptoms was found. Her symptoms were self-limiting and improved with supportive management. This case illustrates an important example of viral central nervous system infection presenting clinically as meningitis but with normal CSF microscopy.
Footnotes
Contributors: All authors have contributed to the article conception, design, collection of information, analysis, discussion, drafting, critical revision of content and final approval.
Competing interests: None.
Patient consent: Obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.
References
- 1. Patriquin G, Hatchette J, Forward K. Clinical presentation of patients with aseptic meningitis, factors influencing treatment and hospitalization, and consequences of enterovirus cerebrospinal fluid polymerase chain reaction testing. Can J Infect Dis Med Microbiol 2012;23:e1–5
- 2. Ihekwaba UK, Kudesia G, McKendrick MW. Clinical features of viral meningitis in adults: significant differences in cerebrospinal fluid findings among herpes simplex virus, varicella zoster virus, and enterovirus infections. Clin Infect Dis 2008;47:783–9 [[PubMed]
- 3. Guney C, Ozkaya E, Yapar M, et al Laboratory diagnosis of enteroviral infections of the central nervous system by using a nested RT-polymerase chain reaction (PCR) assay. Diagn Microbiol Infect Dis 2003;47:557–62 [[PubMed][Google Scholar]
- 4. Tanel RE, Kao SY, Niemiec TM, et al Prospective comparison of culture vs genome detection for diagnosis of enteroviral meningitis in childhood. Arch Pediatr Adolesc Med 1996;150:919–24 [[PubMed][Google Scholar]
- 5. Menasalvas-Ruiz AI, Salvador-Garcia C, Moreno-Docon A, et al Enterovirus reverse transcriptase polymerase chain reaction assay in cerebrospinal fluid: an essential tool in meningitis management in childhood. Enferm Infecc Microbiol Clin 2013;31:71–5 [[PubMed][Google Scholar]
- 6. Yun KW, Choi EH, Cheon DS, et al Enteroviral meningitis without pleocytosis in children. Arch Dis Child 2012;97:874–8 [[PubMed][Google Scholar]
- 7. Wolthers KC, Benschop KSM, Schinkel J, et al Human parechoviruses as an important viral cause of sepsis like illness and meningitis in young childrenClin Infect Dis 2008;47:358–63 [[PubMed][Google Scholar]