Other causes of eosinophilic meningitis
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6.12.08
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In early neurocysticercosis, cerebrospinal fluid eosinophilia occurs in 23-53% of patients. Serology (Taenia solium) and antigen detection techniques should be performed on serum and cerebrospinal fluid. Cerebral paragonomiasis occurs in less than 1% of cases with pulmonary involvement. In trichinosis, CSF eosinophilia is very rare. In spinal or cerebral schistosomiasis, CSF eosinophilia is uncommon. Meningitis due to Coccidioides immitis occurs in up to 50% of patients with disseminated disease. In 70% of cases, CSF eosinophilia occurs, and 30% of patients presented with eosinophilic meningitis, making this fungal infection one of the most frequent causes of eosinophilic meningitis in the USA. Cryptococcal meningitis is rarely associated with eosinophilic pleocytosis.
| Etiology | Peripheral eosinophilia | Exposure history | Supporting evidence | Definite diagnosis |
| Angiostrongyliasis | Present in 70% of patients | Southeast Asia, Pacific, Caribbean | MRI and CT-scan show no focal lesions, but can show meningeal enhancement. | Serology Detection of larvae in CSF is rare |
| Gnathostomiasis | Present in >55% | Southeast Asia, Pacific, Latin America | Migratory tissue swelling; focal lesions on MRI or CT-brain. Xanthochromic or bloody CSF | Serology Detection of larvae in CSF is rare. Biopsy of peripheral lesion. |
| Baylisascariasis | Present | Raccoons, including their “latrines” | Diffuse periventricular white matter disease on CT / MRI-brain | Identification of larvae on brain biopsy |
| Coccidioidomycosis | If present, likely with erythema nodosum | Southwest USA | Erythema nodosum ± other skin rash, arthralgia, pulmonary infiltrates | Cultures (CSF, blood, sputum) and serology |
| Malignancy | Rare | none | Focal lesions in brain on CT/MRI; other areas of the body affected by tumor | Tissue biopsy |
| Medications | Not present | Use of ciprofloxacin, ibuprofen, intraventricular gentamycin, vancomycin | Initiation of a new drug | Improvement after removal of drug |
| Ventriculoperitoneal shunt | Not present | neurosurgery | CSF eosinophilia after insertion of shunt | Improvement after removal of shunt |
| Idiopathic hypereosinophilic syndrome | always | none | Infiltration of eosinophils in lungs, heart and nerves | Peripheral eosinophilia >1500/µL for at least 6 months; no underlying etiology known |
Category: Medicine Notes
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