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[Collagen diseases and recurrent meningitis in an 88 year old patient]

Fernando J Vázquez1, Yuquerí Beguelin, Natalia Schutz

  • 1Servicio de Clínica Médica, Hospital Italiano, Gascón 450, 1181 Buenos Aires, Argentina. fernando.vazquez@hospitalitaliano.org.ar

Medicina
|March 24, 2004
PubMed

Insights

Recurrent aseptic meningitis is rare in the elderly, but this case highlights Sjögren Syndrome (SS) and mixed connective tissue disease (MCTD) as potential causes. Early consideration of these conditions is crucial for accurate diagnosis and management in older adults.

Area of Science:

  • Rheumatology
  • Neurology
  • Immunology

Background:

  • Recurrent aseptic meningitis (RAM) is uncommon in elderly patients and often drug-induced.
  • Associations between RAM and rheumatologic diseases are rarely reported in older individuals.
  • Sjögren Syndrome (SS) can involve the central nervous system, but its link to recurrent meningitis is exceptionally rare in the elderly.

Observation:

  • An 88-year-old female presented with a history of xerostomia, xerophthalmia, Raynaud phenomenon, dysphagia, and recurrent parotid enlargement.
  • She experienced two episodes of lymphocytic meningitis, confirmed as aseptic after ruling out infections.
  • Diagnostic workup revealed positive antinuclear antibody (ANA) with a nucleolar-mottled pattern, anti-Ro and anti-RNP antibodies, and lupus anticoagulant, alongside confirmed ocular dryness and lip biopsy findings consistent with SS.

Findings:

  • The patient experienced a complete remission of meningitis within 10 days without specific treatment.
  • The clinical presentation and serological findings suggest a diagnosis of mixed connective tissue disease (MCTD) with predominant SS features.
  • This case represents recurrent meningitis as a rare, isolated manifestation of MCTD/SS in an elderly patient.

Implications:

  • Sjögren Syndrome (SS) and mixed connective tissue disease (MCTD) should be included in the differential diagnosis of recurrent aseptic meningitis (RAM), even in elderly patients.
  • This case underscores the importance of a comprehensive rheumatological and immunological evaluation for elderly patients presenting with unexplained recurrent meningitis.
  • Recognizing these associations can lead to earlier diagnosis and potentially prevent complications in older adults with autoimmune conditions.

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