Haddad Mahboubeh, Sheybani Fereshte, Olfati Nahid, Azhdari Yeganeh
Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Case Rep Med. 2022 Jan 12;2022:7615939. doi: 10.1155/2022/7615939. eCollection 2022.
Post-traumatic meningitis is a potentially fatal condition that presents as a diagnostic and therapeutic challenge. The vast majority of post-traumatic meningitides are caused by infectious pathogens, most commonly multi-drug-resistant (MDR) bacterial pathogens. However, aseptic meningitis occurs less frequently due to tissue response to injury or stimulation by noninfectious agents, such as blood breakdown products or chemicals. Here, we present a case of post-traumatic persistent neutrophilic meningitis who was found to be steroid responsive. Diagnostic evaluation in our patient did not reveal any infectious pathogen, and the patient did not respond to broad-spectrum antimicrobial treatment. We suggest that physicians who treat patients with post-traumatic meningitis should consider steroid-responsive post-traumatic persistent neutrophilic meningitis (SPNM) in the list of differential diagnosis particularly when no infectious etiology is found and the patient does not respond to empirical antimicrobial treatment. Brain injury-induced immune dysregulation causing exaggerated inflammatory reaction might play a role in the pathogenesis of SPNM; however, further neuropathological studies are absolutely necessary to evaluate and characterize trauma-induced immune dysregulation.
创伤后脑膜炎是一种潜在的致命疾病，对诊断和治疗构成挑战。绝大多数创伤后脑膜炎由感染性病原体引起，最常见的是多重耐药（MDR）细菌病原体。然而，无菌性脑膜炎因组织对损伤的反应或非感染性物质（如血液分解产物或化学物质）的刺激而较少发生。在此，我们报告一例创伤后持续性嗜中性粒细胞性脑膜炎患者，发现其对类固醇治疗有反应。对我们患者的诊断评估未发现任何感染性病原体，且患者对广谱抗菌治疗无反应。我们建议，治疗创伤后脑膜炎患者的医生在鉴别诊断清单中应考虑类固醇反应性创伤后持续性嗜中性粒细胞性脑膜炎（SPNM），特别是在未发现感染病因且患者对经验性抗菌治疗无反应时。脑损伤引起的免疫失调导致过度炎症反应可能在SPNM的发病机制中起作用；然而，进一步的神经病理学研究对于评估和表征创伤诱导的免疫失调绝对必要。
