Aseptic meningitis in the setting of giant cell arteritis (GCA): a case report
Lehashenee Thirukumar1, Robin Sia1,2, Justin Jackson3,4
1Department of Medicine, Albury-Wodonga Health, Albury, NSW, Australia.
Insights
Giant cell arteritis (GCA) can present with cerebrospinal fluid (CSF) pleocytosis, mimicking aseptic meningitis. Early GCA diagnosis is crucial for timely corticosteroid treatment and symptom improvement.
Area of Science:
- Neurology
- Rheumatology
- Internal Medicine
Background:
- Giant cell arteritis (GCA) is an inflammatory condition affecting large arteries.
- Diagnosis can be challenging, potentially delaying treatment.
- Cerebrospinal fluid (CSF) pleocytosis is an infrequent finding in GCA, often linked to central nervous system (CNS) involvement.
Purpose of the Study:
- To report a case of GCA presenting with CSF pleocytosis and normal neuroimaging.
- To highlight the association between GCA and aseptic meningitis.
- To emphasize the importance of considering GCA in the differential diagnosis of unexplained aseptic meningitis.
Main Methods:
- A case study of a 76-year-old woman with symptoms of fever, confusion, and headache.
- Investigations included CSF analysis, neuroimaging (MRI), and temporal artery ultrasound.
- Diagnosis of GCA was confirmed by ultrasound, and treatment with corticosteroids was initiated.
Main Results:
- The patient presented with isolated mononuclear CSF pleocytosis.
- Neuroimaging studies were unremarkable.
- Temporal artery ultrasound revealed a halo sign consistent with GCA.
- High-dose corticosteroid therapy led to significant symptom resolution.
Conclusions:
- CSF pleocytosis can be a manifestation of GCA.
- GCA should be considered in patients with aseptic meningitis, even with normal neuroimaging.
- Prompt diagnosis and treatment of GCA are essential for favorable outcomes.
Background:
Giant cell arteritis (GCA) is a vasculitis primarily affecting medium- and large-sized arteries. The diagnosis may be challenging and lead to delays in treatment. Cerebrospinal fluid (CSF) pleocytosis is an uncommon association but may occur due to central nervous system (CNS) vasculitis or pachymeningitis. We describe a case fulfilling the criteria for diagnosing GCA, associated with CSF pleocytosis and normal neuroimaging.
Case Presentation:
A 76-year-old woman presented to our regional hospital with three weeks of fever, confusion and fatigue. Two days later, she developed a right temporal headache with scalp tenderness. Preliminary investigations, including an FDG-PET scan, were unrevealing. Cerebrospinal fluid sampling demonstrated an isolated mononuclear pleocytosis. Brain magnetic resonance imaging (MRI) and an extensive panel of investigations failed to identify a cause, and a diagnosis of aseptic meningitis was made. An ultrasound of her right temporal artery was performed which demonstrated a non-compressible halo sign consistent with GCA. The patient was commenced on high-dose corticosteroid therapy with significant improvement in her symptoms.
Conclusions:
This case strengthens the association of CSF pleocytosis occurring as a complication of GCA and alerts clinicians to consider the possibility of GCA as a potential aetiology for aseptic meningitis.
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