BACKGROUND: The neurological manifestations of Sjögren's syndrome (SjS) are nonspecific and may precede the onset of sicca symptoms. Hence, the diagnosis of SjS is often delayed. Recurrent aseptic meningitis is an uncommon neurological manifestation of primary SjS; only few cases have been reported in the medical literature. CASE REPORT: A 54-year-old woman was admitted for recurrent aseptic meningitis. The patient had a history of two episodes of aseptic meningitis, which had occurred 12 and 7 years before this presentation. The patient had overt sicca symptoms for 5 years. SjS was diagnosed based on the results of serum autoantibody tests, Schirmer's test, and salivary scintigraphy. We concluded that recurrent aseptic meningitis occurred as an initial presentation of primary SjS. CONCLUSION: This case suggest that SjS should be included in the differential diagnosis of recurrent aseptic meningitis.
Autoimmune Diseases ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Meningitis, Aseptic ; Middle Aged ; Neurologic Manifestations ; Radionuclide Imaging ; Sjogren's Syndrome

PURPOSE: Meningitis is an acute childhood infection caused by viral or bacterial infection. The purpose of the present study is to analyze the differences between enteroviral meningitis and non-enteroviral aseptic meningitis. METHODS: From January 2013 to December 2016, we retrospectively reviewed the medical records of a total of 303 aseptic meningitis patients who visited Wonju Severance Christian Hospital. We examined demographics of all patients and analyzed serologic and cerebrospinal fluid tests, clinical symptoms, and outcomes. RESULTS: Of a total of 303 patients, 197(65.0%) were male, and the most cases occurred from June to November (91.8%). The most common pathogen of meningitis was found to be enterovirus (65.0%). According to the etiology, the enteroviral meningitis group had significantly more headache and enteric symptoms (P=0.0003 and P=0.0013, respectively). Furthermore, the non-enteroviral meningitis group showed pleocytosis in the cerebrospinal fluid and a significantly higher rate of seizure at 1 to 4 years (P=0.0360 and P=0.0002, respectively). CONCLUSION: In this study, enteroviral meningitis was the most common and the prognosis was good. When compared between two groups, neurological symptoms were frequent in patients with non-enteroviral meningitis in groups 1 to 4 years.
Bacterial Infections ; Cerebrospinal Fluid ; Child ; Demography ; Enterovirus* ; Gangwon-do ; Headache ; Humans ; Leukocytosis ; Male ; Medical Records ; Meningitis* ; Meningitis, Aseptic ; Prognosis ; Retrospective Studies ; Seizures

Kikuchi-Fujimoto disease (KFD) is known as a self-limiting disease. The most common symptoms include fever, cervical lymphadenopathy, and pain, but nonspecific symptoms such as joint pain, nausea, chills, diaphoresis, and diarrhea may also be present. Its clinical course is generally benign, and symptoms including fever disappear within several months without special treatment. Thus, there is no specific recommended treatment for patients with KFD. However, some patients suffer from prolonged fever or systemic symptoms such as splenomegaly, skin rash, arthralgia, and aseptic meningitis. Many studies have reported the effectiveness of corticosteroids in patients with prolonged fever and systemic symptoms. Our patient also responded favorably to steroids; however, the disease relapsed while tapering. Recently, some studies reported the effectiveness of hydroxychloroquine (HC) in patients with KFD. Herein, we report successful treatment with HC in an adolescent patient with recurrent KFD dependent on steroids without any symptoms of autoimmune disease.
Adolescent ; Adrenal Cortex Hormones ; Arthralgia ; Autoimmune Diseases ; Child ; Chills ; Diarrhea ; Exanthema ; Fever ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Hydroxychloroquine ; Lymphatic Diseases ; Meningitis, Aseptic ; Nausea ; Splenomegaly ; Steroids

BACKGROUND: Varicella-zoster virus (VZV) is one of the most common etiologies of aseptic meningitis. The severest manifestation of VZV meningitis is occasionally confused with tuberculous meningitis (TBM). Thus, we investigated the clinical manifestations of VZV meningitis as compared with those of TBM. MATERIALS AND METHODS: All adult patients who were diagnosed with VZV meningitis or TBM were enrolled at a tertiary hospital in Seoul, South Korea, during an 8-year period. The clinical characteristics and cerebrospinal fluid (CSF) profile of patients were analyzed. RESULTS: Seventy-nine patients with VZV meningitis and 24 patients with TBM were enrolled in this study. Of the 79 patients with VZV meningitis, 63 (80%) did not received empirical anti-tuberculous therapy (Group 1) and the remaining 16 (20%) received empirical anti-tuberculous therapy (Group 2), compared with 24 patients with TBM (Group 3). Altered mental status, intensive care unit (ICU) admission, neurologic sequelae, CSF protein levels, and CSF adenosine deaminase levels revealed a trend of being higher in Group 3 than Group 2, which was higher than Group 1. However, the CSF/serum glucose ratio was significantly lower in Group 3 than in Group 1 or Group 2. CONCLUSION: About one fifth of VZV meningitis cases presented as severe manifestations, mimicking TBM. The CSF/serum glucose ratio might be useful to differentiate VZV meningitis from TBM until definite diagnostic tests are available. Physicians should keep in mind that a differential diagnosis between severe VZV meningitis and TBM is needed.
Adenosine Deaminase ; Adult ; Cerebrospinal Fluid ; Diagnosis, Differential ; Diagnostic Tests, Routine ; Glucose ; Herpesvirus 3, Human ; Humans ; Intensive Care Units ; Korea ; Meningitis* ; Meningitis, Aseptic ; Seoul ; Tertiary Care Centers ; Tuberculosis, Meningeal

BACKGROUND: Herpes zoster (HZ) is caused by reactivation of latent varicella-zoster virus (VZV) infection. HZ-associated aseptic meningitis, a rare complication of HZ, can require hospitalization and a long treatment period. OBJECTIVE: A retrospective study was performed to identify potential factors associated with HZ-associated aseptic meningitis development. METHODS: We included all outpatients and patients admitted in the neurology and dermatology departments of a single tertiary center, who were diagnosed with HZ for two years. Among 818 patients, 578 patients were eligible for analysis. RESULTS: The demographics and potential risk factors were compared between the uncomplicated HZ group (n=554) and aseptic meningitis group (n=24). Among the potential factors, the dermatological distribution of skin rash and gender showed statistically significantly different between the two groups. Patients with craniocervical distribution of HZ accounted for 87.5% (n=21) of the aseptic meningitis group and 54.3% (n=301) of the uncomplicated HZ group (p=0.043). The aseptic meningitis group had more men (66.7%, n=16) than the uncomplicated HZ group (42.8%, n=237, p=0.033). Patients with craniocervical distribution had an odds ratio (OR) of 5.884 (p=0.001) for developing aseptic meningitis when compared with the other dermatome involvements. Additional logistic regression analysis resulted in a fading between gender difference (p=0.050) and craniocervical involvement having an OR of 5.667 for aseptic meningitis (p=0.006). CONCLUSION: In HZ patients, skin rash with craniocervical distribution and male gender were associated with a higher risk of aseptic meningitis.
Demography ; Dermatology ; Exanthema ; Herpes Zoster* ; Herpesvirus 3, Human ; Hospitalization ; Humans ; Logistic Models ; Male ; Meningitis ; Meningitis, Aseptic* ; Neurology ; Odds Ratio ; Outpatients ; Retrospective Studies ; Risk Factors*

A 36-yr-old woman with systemic lupus erythematosus was admitted in our center because of thrombocytopenia that was being treated with corticosteroids. She was prescribed a four-day course of intravenous immunoglobulin (IVIG) infusion. After three days of IVIG infusion, she developed aseptic meningitis with severe pleocytosis in the cerebrospinal fluid, followed by acute kidney injury. These complications resolved completely with conservative management. Here, we report these rare complications of IVIG and the outcome.
Acute Kidney Injury* ; Adrenal Cortex Hormones ; Cerebrospinal Fluid ; Female ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Leukocytosis ; Lupus Erythematosus, Systemic* ; Meningitis, Aseptic* ; Purpura, Thrombocytopenic, Idiopathic* ; Thrombocytopenia

Group B coxsackieviruses (CVBs) are a group of common human pathogens producing various clinical symptoms. Although the virology of CVB is well known, there is limited information on viral pathogenesis and the relationship between clinical symptoms and viral phenotype, particularly for CVB type 2 (CVB2). In 2004 in Korea, two CVB2 strains were isolated: CB2/04/279 from stool of an acute myocarditis patient with heart failure and CB2/04/243 from an aseptic meningitis patient. In this study, a high degree of homology was observed between the CB2/04/279 and CB2/04/243 full genome sequences. The two Korean CVB2 isolates had 93.1% homology compared to 82.1%–82.5% nucleotide sequence identity with the cardiovirulence-associated reference CVB strain Ohio-1 (CVB/O). CVB2-induced pathogenesis was analyzed, focusing on virus-induced pathology of various tissues in 4-week-old BALB/c inbred male mice. Myocarditis developed and extensive pancreatic inflammation was observed in all mice infected with CB2/04/279 or CVB/O, but not in animals infected with CB2/04/243. This is the first report of the full-genomic sequence and pathogenesis of the CVB2 strain isolated from an acute myocarditis patient in Korea.
Animals ; Base Sequence ; Enterovirus ; Genome ; Heart Failure ; Humans ; Inflammation ; Korea* ; Male ; Meningitis, Aseptic* ; Mice* ; Myocarditis* ; Pathology ; Phenotype ; Virology

PURPOSE: To identify the factors associated with differential diagnosis of neonatal bacterial meningitis at the earliest opportunities possible and to evaluate the value of the bacterial meningitis score especially in neonates. METHODS: We conducted a single-center, retrospective study of neonates diagnosed meningitis at our hospital between January 2000 and March 2014. We compared the general characteristics, clinical manifestations, laboratory findings, bacterial meningitis scores between the bacterial group and the aseptic group. RESULTS: Bacterial meningitis differs significantly from aseptic meningitis in platelet count, the cerebrospinal fluid polymorphonuclear leukocyte count, and the serum protein including also the albumin (P<0.05). Except two infants, the bacterial meningitis score over 2 accurately predict bacterial meningitis in the other 11 infants. CONCLUSION: The bacterial meningitis score appears highly useful to identify neonatal infants with bacterial meningitis. However, its diagnostic and prognostic value is just ‘adjunctive’, because low score cannot rule out bacterial meningitis.
Cerebrospinal Fluid ; Diagnosis, Differential ; Humans ; Infant ; Infant, Newborn* ; Meningitis* ; Meningitis, Aseptic ; Meningitis, Bacterial* ; Neutrophils ; Platelet Count ; Retrospective Studies

PURPOSE: Influenza-associated neurologic complications in children are diverse. But there has been little long-term and large-scale research about neurologic complications of seasonal influenza. This study aimed to identify the incidence, characteristics, and risk factors for neurologic complications in children hospitalized with influenza. METHODS: Retrospective analysis was conducted on the clinical data of 940 children hospitalized with confirmed influenza infection from Oct, 2010 to May, 2016 in Kwangju Christian Hospital. RESULTS: A total of 940 children with influenza were hospitalized, of whom 96 (10.2%) had neurologic complications:81 children presented febrile seizures (8.6%) and some included 12 other seizures (1.3%),1 encephalitis (0.1%), 1 Guillain-Barré syndrome (0.1%), 1 aseptic meningitis (0.1%). They had good prognosis except the encephalitis child. The incidence of neurologic complications was significantly higher in influenza A than in influenza B (11.9% vs. 7.0%, P=0.036). The incidence of influenza A was highest in February, while that of influenza B was highest in March and April. The monthly distribution of neurological complications reflected the influenza incidence. The risk factors for influenza-associated neurologic complications were underlying neurologic disease and young age. No significant clinical differences were observed between influenza A and B in febrile seizure. CONCLUSION: Febrile seizures are the most common neurologic complication with good prognosis. Although encephalitis/encephalopathy is rare, it can be severe with sequelae, so prompt diagnosis and treatment should be initiated. And influenza vaccine should be encouraged to children with underlying neurologic disease.
Child* ; Diagnosis ; Encephalitis ; Guillain-Barre Syndrome ; Gwangju ; Humans ; Incidence ; Influenza A virus ; Influenza B virus ; Influenza Vaccines ; Influenza, Human ; Meningitis, Aseptic ; Prognosis ; Retrospective Studies ; Risk Factors ; Seasons* ; Seizures ; Seizures, Febrile

Primary clinical features of rash and neurological complications due to varicella zoster virus (VZV) reactivation are rare in a healthy population, especially in immunocompetent children. Early diagnosis and prompt treatment are delayed often due to their rarity. We present four immunocompetent children with VZV reactivation resulting in aseptic meningitis and herpes zoster affecting multiple cranial and spinal nerves. We reviewed the clinical manifestations, laboratory findings, treatment options and outcome of aseptic meningitis associated VZV reactivation. All patients presented with the typical skin lesion of VZV reactivation and definitive laboratory findings of central nervous system infection, without systemic inflammation. Initial manifestations of VZV reactivation included Ramsay Hunt syndrome, herpes zoster ophthalmicus, and herpes zoster affecting the left thoracic dermatomes 4–5. Intravenous acyclovir was administered and all patients recovered fully without any significant sequelae. VZV reactivation can lead to various neurological complications in immunocompetent children. Early recognition and treatment with acyclovir are important for improving the outcome of neurologic complications of VZV reactivation.
Acyclovir ; Central Nervous System Infections ; Chickenpox ; Child* ; Early Diagnosis ; Exanthema ; Herpes Zoster Ophthalmicus ; Herpes Zoster Oticus ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Inflammation ; Meningitis, Aseptic* ; Skin ; Spinal Nerves