Recurrent Aseptic Meningitis Without Identifiable Pathogens: A Case Report.

Area of Science:

• Neurology
• Infectious Diseases
• Internal Medicine

Background:

• Recurrent meningitis without an identifiable pathogen presents a significant diagnostic challenge, especially with co-existing systemic comorbidities.
• A 66-year-old male with multiple comorbidities experienced five episodes of meningitis over six years.

Observation:

• A 66-year-old male with multiple comorbidities presented with five episodes of meningitis over six years.
• Cerebrospinal fluid (CSF) analysis consistently revealed lymphocytic pleocytosis and elevated protein with sterile cultures.
• Extensive infectious, autoimmune, and paraneoplastic workups were negative; MRI showed pachymeningeal enhancement.

Findings:

• Despite a thorough diagnostic workup, no infectious or systemic cause for the recurrent meningitis was identified.
• The patient's symptoms resolved with supportive care, including analgesia and hydration.
• Idiopathic aseptic meningitis was considered the likely diagnosis given the clinical presentation and negative investigations.

Implications:

• This case highlights the importance of considering idiopathic aseptic meningitis in complex cases of recurrent meningitis.
• A structured diagnostic approach and multidisciplinary team involvement are crucial for managing such challenging cases.
• Avoiding unnecessary antimicrobials and focusing on supportive care can lead to favorable outcomes in idiopathic aseptic meningitis.