Tuberculosis Meningitis

[摘要] Aseptic meningitis has multiple etiologies with viral infection being the most common. Hospitalists should recognize atypical features suggestive of an alternative etiology. This case and literature review will focus on an atypical cause.A 6-year-old previously healthy, fully immunized Hispanic American boy was admitted to the hospital during spring with a 2-week history of headache, vomiting, and fever. He was born in the United States and had never traveled. No one in his home was ill, but a classmate had viral meningitis.One week into his illness, he was evaluated at an outside emergency department.The results of a noncontrasted cranial computed tomography scan, comprehensive metabolic panel, complete blood count, and C-reactive protein were normal. Lumbar puncture and cerebrospinal fluid (CSF) analysis were significant for lymphocytic pleocytosis with 376 white blood cells, low glucose, elevated protein, negative enterovirus and herpes simplex virus polymerase chain reaction, and subjective increased opening pressure. He was admitted to the outside hospital, treated with empirical parenteral antibiotics until CSF bacterial culture results were negative, and discharged from the hospital with a diagnosis of viral meningitis.After discharge, his symptoms progressed with the development of diplopia from a new right sixth cranial nerve palsy. He was admitted to a pediatric children’s hospital after reevaluation in the emergency department with a normal findings on noncontrasted cranial computed tomography scan, laboratory tests, and analogous CSF analysis. His diagnosis at admission was viral meningitis.The patient has aseptic meningitis, but is his clinical course most consistent with a viral etiology or are his progressive symptoms with new cranial nerve palsy suggestive of an alternative, less common cause? Aseptic meningitis includes all causes of meningitis with negative results from bacterial CSF cultures. Viral infection, notably enteroviruses with late summer and fall seasonal outbreaks, is the most common cause.1,2 …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob