Immunoglobulin-Induced Aseptic Meningitis in Juvenile Dermatomyositis: A Case Report

Abstract Background: Aseptic meningitis is a known but unusual serious adverse effect of intravenous immunoglobulin (IVIG). It usually resembles infectious meningitis which makes diagnosis challenging. Case presentation: We report a five-and-a-half-year-old Chinese girl with juvenile dermatomyositis presented with signs of meningismus 21 hours after the initiation of IVIG infusion. Her blood work at diagnosis showed neutrophilia and lymphopenia. The cerebrospinal fluid analysis demonstrated neutrophilic pleocytosis, hyperproteinorrachia and normoglycorrhachia. All microbiological tests were negative. The child recovered fully within 72hours without neurological sequelae.Conclusion: IVIG-induced aseptic meningitis remains a diagnosis of exclusion. Although it is rare, paediatricians should be aware of this complication and avoid unnecessary investigation or treatment.

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Drug-Induced Aseptic Meningitis Following Spinal Anesthesia

European Journal of Case Reports in Internal Medicine ◽

10.12890/2019_001334 ◽

2019 ◽

Author(s):

Ricardo Paquete Oliveira ◽

Mafalda Teixeira ◽

Sofia Cochito ◽

Ana Furtado ◽

Bruno Grima ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Spinal Anesthesia ◽

Aseptic Meningitis ◽

Cerebrospinal Fluid Analysis ◽

Drug Induced ◽

Neurological Sequelae ◽

Fluid Analysis ◽

Empirical Antibiotics ◽

Uncommon Complication

Meningitis is a very uncommon complication of spinal anesthesia, and drug-induced aseptic meningitis (DIAM) is even rarer. We present two cases of DIAM following spinal anesthesia with bupivacaine and ropivacaine, respectively. The patients presented shortly after the procedure with typical meningitis symptoms. Since CSF (cerebrospinal fluid) analysis could not initially exclude bacterial meningitis, they were started on empirical antibiotics. CSF was subsequently found to be negative for viruses and bacteria in both cases, and antibiotics were promptly stopped. Both patients improved rapidly and without neurological sequelae. While it remains a diagnosis of exclusion, it is important to be aware of DIAM as recognition of the condition can lead to shorter admission times and avoid unnecessary use of antibiotics.

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Benign Recurrent Aseptic Meningitis (Mollaret’s Meningitis) in an Elderly Male: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.6950 ◽

2021 ◽

Vol 59 (241) ◽

pp. 916-918

Author(s):

Swati Chand ◽

Sangharsha Thapa ◽

Khusal Gautam ◽

Anu Radha Twayana ◽

Maryrose R.Laguio-Vila ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Cerebrospinal Fluid ◽

Aseptic Meningitis ◽

Acute Onset ◽

Chain Reaction ◽

Elderly Male ◽

Cerebrospinal Fluid Analysis ◽

Fluid Analysis ◽

Polymerase Chain ◽

Mollaret's Meningitis

Mollaret’s meningitis is an aseptic recurrent benign lymphocytic meningitis lasting 2-5 days and occurs over years with spontaneous complete resolution of symptoms between episodes. An 88 years-old-male presented with acute onset headache, lethargy and altered sensorium after a recent ear infection. He had multiple similar episodes in the past, each preceded by ear or sinus infection with cerebrospinal fluid finding consistent with aseptic meningitis. However, no specific causative agent was ever identified. He was confused, disoriented and lethargic with normal vitals and systemic examination. Blood tests showed leukocytosis with neutrophilia. Cerebrospinal fluid analysis revealed increased cell count with lymphocyte predominance, elevated protein and negative polymerase chain reaction. Magnetic resonance imaging of brain showed chronic small vessel ischemic changes. He fulfilled the Bruyn’s criteria for clinical diagnosis. He was empirically administered acyclovir during hospitalization and was discharged without prophylactic antiviraldue to negative cerebrospinal fluid analysis, culture, and multiplex polymerase chain reaction.

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