Liquor klar – Diagnose (un)klar

Zusammenfassung

Anamnese Eine 35-jährige Patientin stellte sich mit akuten starken Kopfschmerzen, Photophobie und Fieber vor. Mehrere Mitglieder der Familie der Patientin litten vorgängig an der Hand-Mund-Fuß-Krankheit.

Status und Befunde Klinisch fiel ein prominenter Meningismus auf. Lumbalpunktion und kraniales Computertomogramm waren unauffällig. Im weiteren Verlauf fiel die PCR-Untersuchung des Liquors positiv für Enteroviren-Spezies-RNA aus.

Diagnose und Therapie Bei bestätigter Enteroviren-Meningitis konnte die initial verabreichte antimikrobielle Therapie sistiert und auf weiterführende Diagnostik verzichtet werden.

Verlauf Die Symptome waren rasch und vollständig regredient.

Folgerungen Dieser Fall soll aufzeigen, dass bei typischer Klinik einer Meningitis ohne Liquorpleozytose die Enteroviren-Meningitis auch bei adulten Patienten eine wichtige Differenzialdiagnose darstellt.

Abstract

History A 35-year-old, previously healthy woman presented with short history of headache and fever. Several other family members reported active hand, foot, and mouth disease.

Findings Clinical findings showed subfebrile temperatures and a prominent meningism. Cerebrospinal fluid and computed tomography of the head were unrevealing. Subsequent PCR-analysis of the cerebrospinal fluid was positive for Enteroviral-RNA.

Diagnosis and Therapy Enteroviral-meningitis was diagnosed. The empirically administered antimicrobial therapy was stopped and further diagnostic tests could be withheld.

Course Symptom-oriented therapy resulted in complete resolution within the next few days.

Conclusions Our case emphasizes that, in patients with typical signs of meningeal irritation, normal cellular analysis of the cerebrospinal fluid does not exclude the presence of infectious meningitis. The astute clinician should be reminded that this constellation is highly suggestive of enteroviral meningitis.

Schlüsselwörter

Meningitis - Liquor - Enteroviren - Hand-Fuß-Mund-Krankheit

Key words

meningitis - cerebrospinal fluid - enterovirus - hand-foot-and-mouth disease

Publication History

Article published online:
28 December 2021

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