Campero Mario, Espinoza Ricardo, Silva Carlos
Departamento de Neurología y Medicina Interna, Clínica Las Condes, Santiago, Chile.
Departamento de Neurología & Neurocirugía, Hospital Clínico, Universidad de Chile, Santiago, Chile.
Rev Med Chil. 2020 Dec;148(12):1844-1847. doi: 10.4067/S0034-98872020001201844.
Aseptic meningitis represents a diagnostic challenge for the clinician. Cytological and chemical parameters are key in the differential diagnosis. Hypoglycorrhachia is a strong predictor of a bacterial origin for aseptic meningitis. We report a 44-year-old male with a history of recurrent febrile headaches admitted with fever and delirium. The initial cerebrospinal fluid (CSF) analysis showed low glucose levels. Magnetic resonance imaging did not show abnormalities. The patient was discharged but was admitted again three weeks later with fever, headache and a stiff neck. The CSF was inflammatory with low glucose levels. Serology for brucellosis was positive. The patient was treated with ceftriaxone and rifampicin with a good clinical response.
无菌性脑膜炎对临床医生来说是一项诊断挑战。细胞学和化学参数在鉴别诊断中至关重要。脑脊液低糖是无菌性脑膜炎细菌感染源的有力预测指标。我们报告一名44岁男性，有反复发热性头痛病史，因发热和谵妄入院。初始脑脊液分析显示葡萄糖水平低。磁共振成像未显示异常。患者出院，但三周后因发热、头痛和颈部僵硬再次入院。脑脊液呈炎性且葡萄糖水平低。布鲁氏菌病血清学检查呈阳性。患者接受头孢曲松和利福平治疗，临床反应良好。
