Recurrent meningitis

Differential Diagnosis

• Immune defects
  • Asplenia
  • Hypogammaglobulinemia
  • Complement deficiencies, including properdin deficiency, terminal complement deficiency, and use of eculizumab
• Parameningeal focus of infection
• Structural abnormalities
  • Post-neurosurgery
  • CSF leak or CSF fistula
  • Dermal sinus
  • Epidermoid cyst
  • Craniopharyngioma
• Drugs
  • TMP-SMX
  • NSAIDs
  • IVIg
  • OKT3
  • Phenytoin
• Infections
  • HSV-2 (Mollaret's disease)
• Inflammatory
  • SLE
  • Behçet disease

Specific Patients

Terminal Complement Deficiency

• Prone to recurrent neisserial infections

Hypogammaglobulinemia

• Can develop chronic meningoencephalitis, primarily cause by:
  • Enterovirus
  • Mycoplasma