title: [Case of Neuro-Behçet disease resembling bacterial meningitis].
abstract: 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 papilloedema. He also showed pleocytosis (1,066/microl, 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-BehCet (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.
authors.affiliation: Department of Neurology, Tohoku University School of Medicine.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nezu
authors.forename: Naoki
authors.initials: N
authors.lastname: Suzuki
authors.forename: Hideki
authors.initials: H
authors.lastname: Mizuno
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Takai
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Misu
authors.forename: Masashi
authors.initials: M
authors.lastname: Aoki
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakashima
authors.forename: Yasuto
authors.initials: Y
authors.lastname: Itoyama
mesh_terms: D000328:Adult; D001528:Behcet Syndrome / Q000175:diagnosis* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial; D008775:Methylprednisolone / Q000008:administration & dosage; D011498:Protein Precursors / Q000097:blood*; D020551:Pulse Therapy, Drug; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide; D008775:Methylprednisolone