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Infectious meningitis with atypical cerebrospinal fluid cells

J C García-Moncó1, M G Beldarrain, I Zabalza

  • 1Department of Neurology, Hospital de Galdacano, 48960 Galdacano, Vizcaya, SpainDepartment of Pathology, Hospital de Galdacano, 48960 Galdacano, Vizcaya, Spain.

European Journal of Neurology
|November 29, 2013
PubMed

Insights

Distinguishing neoplastic from reactive cells in cerebrospinal fluid (CSF) is challenging. This study highlights that atypical lymphocytes in CSF can stem from infections like meningitis, not necessarily cancer, guiding appropriate treatment.

Area of Science:

  • Neurology
  • Cytopathology
  • Infectious Diseases

Background:

  • Cytologic evaluation of cerebrospinal fluid (CSF) poses diagnostic challenges in differentiating neoplastic from reactive cells.
  • Non-neoplastic conditions can present with atypical cells in CSF, necessitating careful clinical consideration to prevent overtreatment.

Purpose of the Study:

  • To report cases of cytologically atypical lymphocytes in CSF due to infectious meningitis.
  • To emphasize the importance of distinguishing reactive cellular changes from neoplastic processes in CSF analysis.

Main Methods:

  • Case series involving three patients with infectious meningitis (Herpes zoster virus and neuroborreliosis).
  • Cytologic examination of CSF.
  • Further characterization using histochemical, immunocytochemical, and cellular genome analysis techniques.

Main Results:

  • Two patients diagnosed with Herpes zoster virus meningitis and one with neuroborreliosis presented with atypical lymphocytes in CSF.
  • Detailed analysis confirmed the pleocytosis in these patients was of reactive origin, not neoplastic.
  • Cytomorphology alone was insufficient for definitive diagnosis in these cases.

Conclusions:

  • Atypical lymphocytes in CSF can be indicative of infectious processes such as meningitis.
  • Advanced diagnostic techniques beyond basic cytomorphology are crucial for accurate differentiation between reactive and neoplastic cells.
  • Correctly identifying reactive cellular changes prevents unnecessary and aggressive therapies.

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