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Arthritis (Expert Forum)
Recurring Mennigitis
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
Recurring Mennigitis
by pate, Feb 26, 2004 12:00AM
A few years back I was Dx. with APL syndrome. I was unable to further my testing due to lack of insurance. In the past 7 mo. I have had Viral mennigitis twice. It has come shortly after having Epidural Steroid Inj. My #'s for the APL have declined to 16 in the past year. No one is sure what is going on. The best answer I can get is that the steroids might be acting on my immune system and hence the Mennigitis. One thought was nsaid induced Mennigitis, but most feel that this is highly unlikley. I am not sure where to turn next, and what test to have. This last bout has been very strange. I have been having alot of neuro signs with it. Excuricating pain in my legs and some stumbling, H/A that feel like they are related to ICP,ie: pain when coughing, bending, etc. Current meds are Verapamil 240 SR and Nurotin 300 TID and Acyclovir 800 TID for 18 days. CSF was typical of viral. Also had the other test PCR, meningelecoccal, etc. all were neg. Any thoughts or suggestion would be greatly appreciated.
Doctor's Answer
by Kevin Pho, MD, Feb 28, 2004 12:00AM
, Feb 28, 2004 12:00AM
Non-bacterial meningitis can be very difficult to diagnose. You are already being treated for most viral causes with the acyclovir. There are variety of tests to consider to pin down the cause.
The CSF should be sent for viral cultures and bacterial culture (in addition to the routine CSF studies). Depending upon the clinical presentation and availability of a reliable and prompt diagnostic laboratory, HSV or enterovirus PCR may also be useful. Other tests to consider include: serum and CSF Venereal Disease Research Laboratory (VDRL), HIV antibody or RNA testing, Lyme serology, and acute/convalescent serologic testing for specific viruses (LCM, mumps, measles).
If those tests are negative, more specialized testing can be considered. Evaluation should include a repeat CSF analysis with removal of large volume of fluid (3 to 5 mL, if possible) for fungal and mycobacterial cultures. Imaging of the CNS and sinuses should be performed with magnetic resonance imaging (MRI) or computed tomography (CT).
An infectious disease referral should be considered for another opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Johnson. Aseptic meningitis. UptoDate, 2004.
The CSF should be sent for viral cultures and bacterial culture (in addition to the routine CSF studies). Depending upon the clinical presentation and availability of a reliable and prompt diagnostic laboratory, HSV or enterovirus PCR may also be useful. Other tests to consider include: serum and CSF Venereal Disease Research Laboratory (VDRL), HIV antibody or RNA testing, Lyme serology, and acute/convalescent serologic testing for specific viruses (LCM, mumps, measles).
If those tests are negative, more specialized testing can be considered. Evaluation should include a repeat CSF analysis with removal of large volume of fluid (3 to 5 mL, if possible) for fungal and mycobacterial cultures. Imaging of the CNS and sinuses should be performed with magnetic resonance imaging (MRI) or computed tomography (CT).
An infectious disease referral should be considered for another opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Johnson. Aseptic meningitis. UptoDate, 2004.
Member Comments
by jillybeans, Mar 19, 2004 12:00AM
I have related symptoms...Jan 04 it started with bladder/kidney stone like symptoms and a severe headache and vomiting. Gradually I lost all ability to urinate and move my bowls accompanied by complete numbness in the "saddle area". After 2 trips to the Emergency room and 7 Doctors later, a neurologist diagnosed me with Cauda Equina Syndrome (probably caused by a virus)Herpes/Shingles No one knows for sure what the virus is or was but I'm still having reprocussions from this ie sciatica, numbness & tingling down my legs and at the bottoms of my feet when I stretch my neck. Thank God I am able to go to the bathroom on my own now though. I was self cathing for 2 weeks! I did have a CAT scan and and MRI which were both normal. I guess something like this takes time to run it's course. Sometimes up to 2 years I heard. Steroidal injections are the worse thing you can do if you have an infection in your spine. My best advise to you is to get some good vitamins and take amino acids (L-Lysine) and start boosting your immune system. Garlic is great for that! I did break out in shingles from this so they're (the Dr.'s) are thinking its the Herpes virus, like chickenpox. I feel like I'm falling apart and I'm only 32!
