A case of Neuro-Behçet disease resembling bacterial meningitis

Masahiro Nezu, Naoki Suzuki, Hideki Mizuno, Yoshiki Takai, Tatsuro Misu, Masashi Aoki, Ichiro Nakashima, Yasuto Itoyama

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A 30-year-old man with intractable headache and high fever came to the emergency room. He presented skin eruption, aphtha, drowsiness (E3, V4, M6 /GCS), meningeal sign, hyperreflexia, and bilateral papilledema. He also showed pleocytosis (1,066 /μl, polymorphonuclear cells predominantly) and pressure increase in CSF. WBC count and CRP were elevated. Two years before, he had meningeal sign, cervical myelitis, skin eruption, uveitis, and aphtha, and was diagnosed as Neuro-Behçet (NBD) disease. HLA-B52 and B55 were positive. We suspected recurrent NBD, but we couldn't exclude bacterial meningitis because of his symptoms and cell-pattern in CSF. We treated him with intravenous methylpredonisolone and antibiotics (MEPM 6 g/day and VCM 2 g/day). His symptoms dramatically improved within a few days. The rapid improvement might be attributed to the steroids. Furthermore, MRI FLAIR images showed multiple small high lesions in the brainstem, hemispheres, subcortical area, putamen and left cerebellar hemisphere. Serum procalcitonin was not increased. We diagnosed the recurrence of NBD retrospectively. Procalcitonin may be a useful marker for discrimination between meningitis due to NBD and septic meningitis.

Original languageEnglish
Pages (from-to)750-753
Number of pages4
JournalClinical Neurology
Issue number10
Publication statusPublished - 2008 Oct


  • Bacterial meningitis
  • Neuro-Behçet disease
  • Procalcitonin


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