[CIS-PAGID] infantile recurrent aseptic meningitis

[Cooper, Megan]

Hi Everyone -

I have a challenging patient I was asked about.  This is a 3mo (former 36 week EGA) with recurrent aseptic meningitis.  He has now had 4 episodes plus a rule out sepsis evaluation as a newborn.  With these he has fever and irritability, CSF pleocytosis with neutrophil predominance (CSF nucleated cell counts 31-775), normal CSF protein/glucose, and on CBC elevated WBC and platelets.  He also has elevated monocytes on CBC (7-19%).  ESR/CRP were only checked once and were normal.  He has no rash, arthritis, or other symptoms.

Cultures have all been negative, although he seems to respond to antibiotics and had a normal CSF cell count after 1 week of abx with one of the episodes.  An extensive ID workup was negative (including CSF 16S sequencing, see below for everything I could find if you are interested) and MRI of brain and C/T/L spine was normal twice except for fluid in the middle ear - I think ENT got a fluid sample and they are culturing.

He has a normal immune work up so far:
Ig (IgG 275, IgA 12.9, IgM 37)
Flow normal: CD3 3970, CD4 2836, CD8 1008, CD19 1954, CD56/16 378, HLA-DR+ T cells 0
Mitogen proliferation
NOB

Any thoughts?  Cryopyrin sequencing is pending (but no rashes or arthritis).  Without an identified organism I am hesitant to think immune deficiency, perhaps an autoinflammatory disorder, but he doesn't have any other symptoms.

Thanks,

Megan

Megan Cooper, MD, PhD
Instructor, Pediatric Rheumatology and Immunology
Washington University
St. Louis Children's Hospital


ID evaluation negative:
CSF routine, fungal, AFB, LCMV, blastomyces, cryptococcal, parechovirus, enterovirus, HSV; 16S sequencing
Other: PPD; Toxoplasma; RPR; HIV; PCR for VZV, M pneumonia, HSV, enterovirus, EBV, CMV, NP swab, urine


The materials in this email are private and may contain Protected Health Information. If you are not the intended recipient, be advised that any unauthorized use, disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this email in error, please immediately notify the sender via telephone or return email.
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/mailman/private/pagid/attachments/20120326/5168e8e5/attachment.htm>