A Case Report: A 63 Year Old Male with Atypical Presentation of Viral Meningitis

Introduction: Viral meningitis usually presents with headache, fever and signs of meningeal irritation in immunocompetent adult. Nuchal rigidity and profound alteration of consciousness usually present. Viral meningitis may remain a diagnostic enigma without molecular techniques. Rapid molecular assays are the great advancement for the diagnosis of difficult to grow pathogens such as viruses and thus can become a big tool in antimicrobial stewardship.

Objective: This case report aims to present a 63-year-old male with atypical presentation of viral meningitis which managed and discharged after 18th day of hospitalization.

Case presentation: We presented a case of B.E a 63 years old male, worked as engineer came in with chief complaint of fever, intermittent for four days. No other associated symptoms noted such as headache, blurring and body weakness. After 3 days of hospitalization, still with intermittent low grade fever without any associated complaints. On succeeding days of admission, patient developed sudden generalized body weakness and photophobia. All laboratory exams such as CT scan, electrolytes and complete blood count revealed normal. Vital signs and Physical examination were unremarkable. Lumbar puncture was done on 6th hospital day due to classic symptoms of meningitis such as photophobia and headache. The diagnosis was concluded as viral meningitis based on clinical presentation and CSF fluid analysis. Phadebac was requested after CSF analysis and no microorganisms were isolated. Patient was managed accordingly with acyclovir, steroids and mannitol. The neurologist and infectious disease specialist signed out the case as viral meningitis with conclusive laboratory result.

Conclusion: Viral meningitis is the most common type of meningitis, and patient will present to you with fever and constitutional signs and symptoms. The usual manifestations of meningitis are fever, signs of meningeal irritation in immunocompetent adult. Upon presentation, most patients report fever, headache, irritability, nausea and vomiting, stiff neck, rash or fatigue within the previous 18-36 hours. Headache is almost always present in patients with viral meningitis and is often reported as severe. In our patient, he presented with low grade fever alone, no meningeal nor headache were noted. The appearance of headache, nuchial rigidity and photohobia were noted late which make this case atypical presentation of viral meningitis.

Author(s): Allen M. Quirit

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