Aseptic meningitis is diagnosed using clinical and laboratory findings of meningeal inflammation in the absence of bacteria in cerebrospinal fluid smear and culture. It is commonly caused by a viral infection, and most cases are improved without specific treatment. We present a case of aseptic meningitis in a 33-yearold Japanese man that was diagnosed only after a repeat lumbar puncture. The patient had a positive ocular globe compression sign with no other positive meningeal signs. This case highlights the importance of repeated lumbar puncture in patients with suspected aseptic meningitis if the initial lumbar puncture results are negative, and there is a clinical value in assessing the ocular globe compression sign, particularly when other clinical signs of meningitis are absent.
This report describes a case of aseptic meningitis suspected of having
positive ocular globe compression sign in a 33-year-old man who was
diagnosed only after repeated lumbar puncture. We highlight the
importance of repeat lumbar puncture and the clinical value of ocular
globe compression sign in suspecting aseptic meningitis.
Patient: Female, 61-year-old
Final Diagnosis: Infectious endocarditis
Symptoms: Fever
Clinical Procedure: —
Specialty: Infectious Diseases
Objective:
Unusual clinical course
Background:
Infective endocarditis (IE), a systemic infection characterized by bacterial vegetative growths on heart valves and endothelium, often manifests variably and leads to severe complications, sometimes even death. Accurate and timely diagnosis is paramount, yet the variety of symptoms can lead to delays, especially amidst the complexities of the ongoing COVID-19 pandemic.
Case Report:
A 61-year-old woman with a history of mitral valve regurgitation was admitted after a month of low-grade fever, night sweats, and polyarthritis. Initial blood cultures and CT scans were inconclusive. Upon admission, clinical examination uncovered a heart murmur, leukocytosis, and elevated C-reactive protein levels. Further examination by another physician revealed conjunctival hemorrhage and Janeway lesions. Subsequent blood cultures tested positive for
Streptococcus oralis
, and transesophageal echocardiography revealed mitral valve prolapse with vegetation, leading to a diagnosis of IE. Following a 6-week course of ampicillin, the patient recovered successfully.
Conclusions
: This case underlines the necessity of maintaining a high index of suspicion and flexible diagnostic approach, particularly in high-risk patients and complex care environments like the COVID-19 pandemic. A single inconclusive test should not preclude a diagnosis, underscoring the importance of repeated testing and comprehensive assessments in timely disease identification.
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