title: Confirmed viral meningitis with normal CSF findings.
abstract: An 18-year-old woman presented with a progressively worsening headache, photophobia feverishness and vomiting. Three weeks previously she had returned to the UK from a trip to Peru. At presentation, she had clinical signs of meningism. On admission, blood tests showed a mild lymphopenia, with a normal C reactive protein and white cell count. Chest X-ray and CT of the head were normal. Cerebrospinal fluid (CSF) microscopy was normal. CSF protein and glucose were in the normal range. MRI of the head and cerebral angiography were also normal. Subsequent molecular testing of CSF detected enterovirus RNA by reverse transcriptase PCR. The patient's clinical syndrome correlated with her virological diagnosis and no other cause of her symptoms was found. Her symptoms were self-limiting and improved with supportive management. This case illustrates an important example of viral central nervous system infection presenting clinically as meningitis but with normal CSF microscopy.
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: Naghum
authors.initials: N
authors.lastname: Dawood
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: Edouard
authors.initials: E
authors.lastname: Desjobert
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: Janine
authors.initials: J
authors.lastname: Lumley
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Webster
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D000698:Analgesia / Q000379:methods*; D000932:Antiemetics / Q000627:therapeutic use*; D004769:Enterovirus Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D005440:Fluid Therapy; D006261:Headache / Q000382:microbiology* / Q000821:virology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000382:microbiology; D014195:Travel; D016896:Treatment Outcome; D014839:Vomiting / Q000382:microbiology* / Q000821:virology
chemical_list: D000932:Antiemetics