Meningitis crónica autoinmune secundaria a meningitis aguda por neumococo. Caso clínico

Abstract

Autoimmune chronic meningitis secondary to pneumococcal meningitis. Report of one case Pneumococcal meningitis produces several inflammatory disorders in susceptible subjects. A worsening of meningitis can occur on the fourth day of evolution in relation with the withdrawal of steroids. Other complications include the development of inflammatory signs in the post-acute stage of infection associated with disseminated vasculitis of the cerebral blood vessels and, even later, an autoimmune chronic meningitis. All these inflammatory complications are well controlled with the use of steroids. We report a 53-year-old woman with pneumococcal meningitis that had a good response to treatment with antibiotics and steroids. On the four day, after the steroids were discontinued, she complained of headache, became confused, and had an abnormal cerebrospinal fluid (CSF), report CT angiography showed signs of arteritis. She improved when the steroids were re-started. She was discharged in good condition but after slow tapering of the steroids over a four-month period she had a relapse of all her symptoms and had a gait disturbance. On readmission, she had an inflammatory CSF, there were no signs of infection and the cerebral MRI showed meningeal thickening with ventricular space enlargement. She improved again with steroids and she is now well on high-dose steroids but deteriorates each time the steroids are stopped. She experienced both acute and sub-acute inflammatory responses and finally developed a chronic meningitis responsive, and is dependent on steroids. (Rev Med Chile 2019; 147: 803-807)

Reassessment of Pediatric Tension-Type Headaches

“…42 43 In addition to pachymeningitis, various types of headache-producing inflammatory autoimmune conditions of the central nervous system have been well described very recently. 44 45 46 Besides cases involving the dura, autoimmune encephalitis has been more frequently recognized over the past 10 years. 47 Not all of these disorders are Streptococcus -related, but if group A β-hemolytic streptococcal infections produce an autoimmune aftereffect, ASLO titers will be elevated and meningeal signs will be apparent in the dura mater.…”