Immunoglobulin-induced aseptic meningitis: a case report

Area of Science:

• Neurology
• Immunology
• Rheumatology

Background:

• Immunoglobulin-associated meningitis is a rare condition that can mimic infectious meningitis.
• Systemic Lupus Erythematosus (SLE) is a known risk factor for drug-associated aseptic meningitis.
• This is the first reported case of immunoglobulin-associated meningitis in a patient with SLE and hypogammaglobulinemia secondary to Rituximab therapy.

Observation:

• A 46-year-old female with a history of SLE presented with meningismus 36 hours after her first intravenous immunoglobulin infusion.
• Cerebrospinal fluid analysis revealed neutrophilic pleocytosis and hyperproteinorrachia.
• All microbiological tests were negative, ruling out infectious causes.

Findings:

• The patient experienced a rapid and complete recovery without sequelae after a five-day course of antibiotic therapy.
• The clinical presentation and cerebrospinal fluid findings were consistent with immunoglobulin-associated meningitis.
• The patient's underlying SLE and Rituximab-induced hypogammaglobulinemia may have predisposed her to this rare condition.

Implications:

• Systemic Lupus Erythematosus may be a risk factor for developing immunoglobulin-associated meningitis.
• Clinicians should consider immunoglobulin-associated meningitis in patients receiving immunoglobulin therapy, especially those with SLE.
• This diagnosis is important as it is a self-limited condition requiring only supportive treatment.