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Published on: May 19, 2020

Meningitis in mixed connective tissue disease complicated by herpes virus infection: case report

Edit Bodolay1, Péter Diószeghy, József Demeter

  • 1Division of Clinical Immunology, Third Department of Internal Medicine, University of Debrecen Medical and Health Science Center, 4004 Debrecen, Móricz Zs. 22., Hungary. bodolai@iiibel.dote.hu

Rheumatology International
|February 27, 2004
PubMed

Insights

A rare case of mixed connective tissue disease (MCTD) flare following herpes zoster infection presented with meningitis. Corticosteroid treatment rapidly improved symptoms, highlighting diagnostic challenges in autoimmune disease complications.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Neurology

Background:

  • Mixed connective tissue disease (MCTD) is a rare autoimmune disorder with variable clinical manifestations.
  • Patients with autoimmune conditions may be at increased risk for infections and disease flares.
  • Herpes zoster infection can trigger or exacerbate underlying autoimmune processes.

Observation:

  • A female patient with MCTD in remission developed herpes zoster infection, leading to a disease flare.
  • The MCTD flare was associated with the onset of meningitis, posing a diagnostic challenge.
  • Differential diagnosis considered meningitis secondary to herpes virus versus aseptic meningitis related to MCTD activity.

Findings:

  • Laboratory findings included leukocytopenia, elevated anti-U1 ribonucleoprotein autoantibodies, increased immune complexes, and decreased complement levels.
  • Cerebrospinal fluid analysis was crucial in differentiating infectious versus autoimmune meningitis.
  • The clinical presentation and laboratory markers pointed towards an autoimmune-driven meningitis exacerbation.

Implications:

  • This case underscores the importance of considering autoimmune disease activity in patients with MCTD experiencing infections.
  • Prompt diagnosis and management of MCTD flares, even in the context of infection, are critical for patient outcomes.
  • Corticosteroid therapy demonstrated efficacy in managing the complex interplay of infection and autoimmune activity in this rare presentation.

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