MOFFITT AM REPORT PEARLS 8/10/16: Eosinophilic Meningitis!

Thanks to Tim for presenting a fascinating and sad case involving multiorgan failure and CSF pleocytosis. Special thanks also to Nicole Rosendale for being our neurology guest consultant for the morning!

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Today’s Top Pearl: Only multicellular parasites (worms and flukes) should cause an eosinophilic meningitis; unicellular parasites (e.g. amoeba) should not.

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For those interested in more detail:

See this prior blog post for the ddx of multiorgan dysfunction: https://ucsfmed.wordpress.com/2016/07/11/moffitt-am-report-pearls-71116-multiorgan-failure-and-multiple-myeloma/

 

Categories of disease to consider for eosinophilic meningitis:

 

  • Multicellular parasites (worms and flukes)
  • Fungal: Cocci
  • Atypical bacterial/mycobacterial: TB, syphilis, RMSF
  • Viral: Coxsackie, LCMV
  • Malignancy (lymphoma, myeloprolifrative neoplasm aka. Hypereosinophilic syndrome)
  • Infiltrative disease (sarcoid)
  • Vasculitis
  • Medications

From a 2013 review recommended by Harry for the ddx of eosinophilic meningitis:

Pic 1.png

And here’s a nasty pic of some WERMS!!

Pic 2

Adult A. cantonensis. Male is on the left, female on the right. Cue romantic music.

 

Evernote: https://www.evernote.com/shard/s272/sh/c86a9a9a-b381-418c-8a7e-007afffb73ea/d748aa5dab5ee4276f735b2452774b19

 

 

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