TY - JOUR
T1 - A case of Neuro-Behçet disease resembling bacterial meningitis
AU - Nezu, Masahiro
AU - Suzuki, Naoki
AU - Mizuno, Hideki
AU - Takai, Yoshiki
AU - Misu, Tatsuro
AU - Aoki, Masashi
AU - Nakashima, Ichiro
AU - Itoyama, Yasuto
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2008/10
Y1 - 2008/10
N2 - A 30-year-old man with intractable headache and high fever came to the emergency room. He presented skin eruption, aphtha, drowsiness (E3, V4, M6 /GCS), meningeal sign, hyperreflexia, and bilateral papilledema. He also showed pleocytosis (1,066 /μl, polymorphonuclear cells predominantly) and pressure increase in CSF. WBC count and CRP were elevated. Two years before, he had meningeal sign, cervical myelitis, skin eruption, uveitis, and aphtha, and was diagnosed as Neuro-Behçet (NBD) disease. HLA-B52 and B55 were positive. We suspected recurrent NBD, but we couldn't exclude bacterial meningitis because of his symptoms and cell-pattern in CSF. We treated him with intravenous methylpredonisolone and antibiotics (MEPM 6 g/day and VCM 2 g/day). His symptoms dramatically improved within a few days. The rapid improvement might be attributed to the steroids. Furthermore, MRI FLAIR images showed multiple small high lesions in the brainstem, hemispheres, subcortical area, putamen and left cerebellar hemisphere. Serum procalcitonin was not increased. We diagnosed the recurrence of NBD retrospectively. Procalcitonin may be a useful marker for discrimination between meningitis due to NBD and septic meningitis.
AB - A 30-year-old man with intractable headache and high fever came to the emergency room. He presented skin eruption, aphtha, drowsiness (E3, V4, M6 /GCS), meningeal sign, hyperreflexia, and bilateral papilledema. He also showed pleocytosis (1,066 /μl, polymorphonuclear cells predominantly) and pressure increase in CSF. WBC count and CRP were elevated. Two years before, he had meningeal sign, cervical myelitis, skin eruption, uveitis, and aphtha, and was diagnosed as Neuro-Behçet (NBD) disease. HLA-B52 and B55 were positive. We suspected recurrent NBD, but we couldn't exclude bacterial meningitis because of his symptoms and cell-pattern in CSF. We treated him with intravenous methylpredonisolone and antibiotics (MEPM 6 g/day and VCM 2 g/day). His symptoms dramatically improved within a few days. The rapid improvement might be attributed to the steroids. Furthermore, MRI FLAIR images showed multiple small high lesions in the brainstem, hemispheres, subcortical area, putamen and left cerebellar hemisphere. Serum procalcitonin was not increased. We diagnosed the recurrence of NBD retrospectively. Procalcitonin may be a useful marker for discrimination between meningitis due to NBD and septic meningitis.
KW - Bacterial meningitis
KW - Neuro-Behçet disease
KW - Procalcitonin
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U2 - 10.5692/clinicalneurol.48.750
DO - 10.5692/clinicalneurol.48.750
M3 - Article
C2 - 19086433
AN - SCOPUS:59449099603
VL - 48
SP - 750
EP - 753
JO - Clinical Neurology
JF - Clinical Neurology
SN - 0009-918X
IS - 10
ER -