A Case of Aseptic Meningitis

Abstract

We report a case of 33-year-old female who was diagnosed as aseptic meningitis. The patient presented with fever, headache, and sore throat for several days. White coats were observed on her nasopharynx and aphthae were on her palatine- and lingual-tonsils, and the inflammatory response was high (white blood cells 9600/μl, CRP 9.18 mg/dl). She was diagnosed as acute pharyngitis. Sulbactam/ampicillin was administrated intravenously. Although local findings were improved, inflammatory response remained high and headache got worse. There was no abnormal findings in her brain CT. The level of consciousness was clear, and the neck stiffness and Kernig sign were negative. The lumbar puncture revealed increase in the number of cells (516/μl. Mononuclear cell 55%, polynuclear cell 45%), protein (39 mg/dl), and glucose (58 mg/dl, the blood glucose level was 92 mg/dl). Aseptic meningitis was suspected, and she was referred to the department of neurology. Considering the possibility of herpes simplex meningitis, acyclovir was administrated intravenously. Her headache improved promptly and she was discharged on the 14th day. Neither herpes simplex virus nor varicella zoster herpes virus was detected in the cerebrospinal fluid PCR test.

Aseptic meningitis is less likely to cause neurological manifestations except headache, such as conscious disturbance, than bacterial meningitis. Because only nonspecific symptoms are observed in many of the cases, lumbar puncture is required for diagnosis. Otherwise, it is often overlooked. When deteriorating headache and persisted pharyngitis were observed like in this case, the possibility of aseptic meningitis should be considered.