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Dtsch Med Wochenschr 2022; 147(01/02): 43-45
DOI: 10.1055/a-1666-7794
Kasuistik

Liquor klar – Diagnose (un)klar

A clear cerebrospinal fluid – but an unclear diagnosis
Raphaël Tamò
  Klinik Innere Medizin Standort Triemli, Department Innere Medizin, Stadtspital Zürich
,
Elisabeth Simons
  Klinik Innere Medizin Standort Triemli, Department Innere Medizin, Stadtspital Zürich
,
Lars C. Huber
  Klinik Innere Medizin Standort Triemli, Department Innere Medizin, Stadtspital Zürich
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Zusammenfassung

Anamnese Eine 35-jährige Patientin stellte sich mit akuten starken Kopfschmerzen, Photophobie und Fieber vor. Mehrere Mitglieder der Familie der Patientin litten vorgängig an der Hand-Mund-Fuß-Krankheit.

Status und Befunde Klinisch fiel ein prominenter Meningismus auf. Lumbalpunktion und kraniales Computertomogramm waren unauffällig. Im weiteren Verlauf fiel die PCR-Untersuchung des Liquors positiv für Enteroviren-Spezies-RNA aus.

Diagnose und Therapie Bei bestätigter Enteroviren-Meningitis konnte die initial verabreichte antimikrobielle Therapie sistiert und auf weiterführende Diagnostik verzichtet werden.

Verlauf Die Symptome waren rasch und vollständig regredient.

Folgerungen Dieser Fall soll aufzeigen, dass bei typischer Klinik einer Meningitis ohne Liquorpleozytose die Enteroviren-Meningitis auch bei adulten Patienten eine wichtige Differenzialdiagnose darstellt.

Abstract

History A 35-year-old, previously healthy woman presented with short history of headache and fever. Several other family members reported active hand, foot, and mouth disease.

Findings Clinical findings showed subfebrile temperatures and a prominent meningism. Cerebrospinal fluid and computed tomography of the head were unrevealing. Subsequent PCR-analysis of the cerebrospinal fluid was positive for Enteroviral-RNA.

Diagnosis and Therapy Enteroviral-meningitis was diagnosed. The empirically administered antimicrobial therapy was stopped and further diagnostic tests could be withheld.

Course Symptom-oriented therapy resulted in complete resolution within the next few days.

Conclusions Our case emphasizes that, in patients with typical signs of meningeal irritation, normal cellular analysis of the cerebrospinal fluid does not exclude the presence of infectious meningitis. The astute clinician should be reminded that this constellation is highly suggestive of enteroviral meningitis.

Schlüsselwörter

Meningitis - Liquor - Enteroviren - Hand-Fuß-Mund-Krankheit

Key words

meningitis - cerebrospinal fluid - enterovirus - hand-foot-and-mouth disease


Publication History

Article published online:
28 December 2021

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Logan SA, MacMahon E. Viral meningitis. Brit Med J 2008; 336: 36-40
    CrossrefPubMedSearch in Google Scholar
  • 2 Kupila L, Vuorinen T, Vainionpää R. et al. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology 2006; 66 (01) 75-80
    CrossrefPubMedSearch in Google Scholar
  • 3 Graf J, Hartmann CJ, Lehmann HC. et al. Meningitis gone viral: description of the echovirus wave 2013 in Germany. BMC Infect Dis 2019; 19 (01) 1010
    CrossrefPubMedSearch in Google Scholar
  • 4 Vareil M, Wille H, Kassab S. et al Clinical and biological features of enteroviral meningitis among adults and children and factors associated with severity and length of stay. J Clin Virol 2018; 104: 56-60 . Epub 2018 May 1
    CrossrefPubMedSearch in Google Scholar
  • 5 Yun KW, Choi EH, Cheon DS. et al. Enteroviral meningitis without pleocytosis in children. Arch Dis Child 2012; 97 (10) 874-878
    CrossrefPubMedSearch in Google Scholar
  • 6 de Crom SC, van Furth MA, Peeters MF. et al. Characteristics of pediatric patients with enterovirus meningitis and no cerebral fluid pleocytosis. Eur J Pediatr 2012; 171 (05) 795-800
    CrossrefPubMedSearch in Google Scholar
  • 7 Dawood N, Desjobert E, Lumley J. et al. Confirmed viral meningitis with normal CSF findings. BMJ Case Rep 2014; 2014: bcr2014203733
    CrossrefPubMedSearch in Google Scholar
  • 8 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 (06) 783-789
    CrossrefPubMedSearch in Google Scholar
  • 9 Mukerji SS, Ard KL, Schaefer PW. et al. Case 32-2020: A 63-Year-Old Man with Confusion, Fatigue, and Garbled Speech. N Engl J Med 2020; 383 (16) 1578-1586
    CrossrefPubMedSearch in Google Scholar
  • 10 UK Meningitis Study Investigators. Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study. Lancet Infect Dis 2018; 18 (09) 992-1003
    CrossrefPubMedSearch in Google Scholar
  • 11 Hasbun R, Rosenthal N, Balada-Llasat JM. et al. Epidemiology of Meningitis and Encephalitis in the United States, 2011-2014. Clin Infect Dis 2017; 65 (03) 359-363
    CrossrefPubMedSearch in Google Scholar
  • 12 Parasuraman TV, Frenia K, Romero J. Enteroviral meningitis. Cost of illness and considerations for the economic evaluation of potential therapies. Pharmacoeconomics 2001; 19 (01) 3-12
    CrossrefPubMedSearch in Google Scholar