Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of aseptic meningitis caused by relapsing polychondritis

Takahide Nagashima, M.D.1)2), Hideaki Tanaka, M.D.1)2), Masafumi Ito, M.D.1)2), Koichi Hirata, M.D.1), Soichi Katayama, M.D.2) and Kazuo Watanabe, M.D.3)

1)Department of Neurology, Dokkyo University School of Medicine
2)Department of Neurology, Southern TOHOKU Research Institute for Neuroscience
3)Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience

We report a patient of relapsing polychondritis (RP) with antecedent aseptic meningitis. A 65-year-old man has developed headache and fever. Neurological examination showed meningeal signs, and cerebrospinal fluid (CSF) examination revealed meningeal inflammation which contained 450 polymorphonuclear cells/μl, 302 mononuclear cells/μl, and 0 red cells/μl, with 79 mg protein/dl. Serologic testing for autoimmune disease as well as the culture and cytology of CSF were negative. He admitted our hospital as having aseptic meningitis and experienced antibiotic therapy. However, his pyrexia continued and he developed repeating visual and hearing impairment reacting to steroid. Three months later, he became behaviorally deaf, and bilateral auricular chondritis occurred with nonerosive seronegative inflammatory polyarthritis. The result of condral biopsy was consistent with the diagnosis of RP showing cartilage surrounded by an intense inflammatory cell response with a decreased number of chondrocytes. A clinical diagnosis was made and prednisolone 60 mg/day was begun with the result of resolution of the auricular chondritis, and slight improvement of his deafness.
Aseptic meningitis is a rare complication of RP. Only one report detailed RP patient who had preceding meningitis. RP is a potentially lethal disease resulting from suffocation by airway collapse, the complications of a cardiac large vessel, and so on. For improvement of a life prognosis, an early diagnosis and treatment are indispensable. Although RP is a rare discovery, it is necessary that RP should be taken into consideration and be differentiated as a cause of relapsing aseptic meningitis.

(CLINICA NEUROL, 46: 40－44, 2006)
key words: relapsing polychondritis, aseptic meningitis, vasculitis, visual impairment, hearing impairment

(Received: 14-Feb-05)