5th August 2024

Aseptic meningitis

There are many other causes of aseptic meningitis, a small number of which will be outlined in this section:

• Primary HIV infection can present as meningitis which often resolves without treatment. It is, therefore, important to routinely screen for HIV in cases of meningitis.
• Mollaret’s meningitis is a recurrent meningitis which is defined as more than 3 episodes of meningism which resolve spontaneously. It is a rare condition and is usually caused by HSV (Herpes simplex virus)-2.
• Aseptic meningitis is a possible complication of mumps infection. Prior to the introduction of the mumps vaccine this was a very common cause of aseptic meningitis.
• Secondary syphilis, caused by the spherocyte Treponema pallidum, can present with meningism and a widespread rash.
• Acute lyme disease can present with a meningitic picture. It is a vector-borne disease caused by infection with Borrelia species which is spread by ticks. Cranial nerve palsies can be present, especially bilateral facial nerve palsy, which is characteristic of this disease. Another classical sign which would point towards this diagnosis is the presence of an erythema migrans rash.
• Rarely, aseptic meningitis can occur in response to a drug reaction. A variety of medications have been associated with this condition including NSAIDs, antibiotics and anti-epileptics.
• Malignant meningitis can occur with invasion by solid tumours or when haematological malignancies spread to the CNS.