SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Neuro Behcets Disease Presenting as Recurrent Aseptic Meningitis

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This case describes a 55-year-old man with type 2 diabetes, complete heart block with pacemaker, nonischemic cardiomyopathy, and Crohn’s disease who was admitted with headache, loss of consciousness, seizures, and nuchal rigidity. Initial workup showed mild leukocytosis but negative CT head, chest X-ray, urinalysis, and urine drug screen. He was treated empirically for possible meningoencephalitis with acyclovir, vancomycin, and ceftriaxone.<br /><br />CSF analysis revealed pleocytosis (90 cells/µL) with mixed neutrophilic and lymphocytic predominance, elevated protein, and high glucose. EEG showed only excessive beta activity without evidence of seizures. MRI could not be obtained because of the pacemaker. Extensive infectious and autoimmune testing was negative, including CSF cultures, HSV, CMV, VZV, anti-NMDAR antibodies, VDRL, EBV, and West Nile virus studies.<br /><br />The report highlights the diagnostic challenge of recurrent aseptic meningitis and emphasizes neuro-Behçet disease as an important consideration. Behçet disease is classically diagnosed by recurrent oral ulcers plus other systemic findings, and neuro-Behçet syndrome is diagnosed using international consensus criteria. The discussion likely stresses the need to consider Behçet-related neurologic involvement when infectious studies are unrevealing, especially in patients with recurrent meningeal symptoms or unexplained inflammatory CSF findings.<br /><br />Overall, the case illustrates how neuro-Behçet disease can present atypically as recurrent aseptic meningitis and mimic infection, making diagnosis difficult without characteristic systemic Behçet features and multidisciplinary evaluation.

Asset Subtitle

Syed R. Shah

Meta Tag

Author List Benton Huang, Maninderjit Singh, Sobia Syed, Syed R. Shah

Category Clinical Vignettes

Concept Recurrent Aseptic Meningitis

Concept Neuro-Behçet Disease

Concept Behçet Disease

Concept Cerebrospinal Fluid

Concept Inflammatory Meningitis

Distinguished Non-Finalist

Presenter Organization University of Washington

Presenting Author Syed R. Shah

Track Adult

Keywords

neuro-Behçet disease

aseptic meningitis

recurrent meningitis

meningoencephalitis

cerebrospinal fluid pleocytosis

Behçet syndrome

type 2 diabetes

pacemaker

seizures

inflammatory CSF findings

Recurrent Aseptic Meningitis

Neuro-Behçet Disease

Behçet Disease

Cerebrospinal Fluid

Inflammatory Meningitis