Recurrent aseptic meningitis as a rare but important presentation of congenital petrous apex cholesteatoma: the value of appropriate imaging

We describe the presentation, investigation and challenging management of a young adult with recurrent aseptic meningitis. The presence of cholesterol and triglycerides in the cerebrospinal fluid sample was recognised as a potential sign of an underlying dermoid or epidermoid cyst. We demonstrate ho...

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Bibliographic Details
Published in:BMJ case reports 2014-03, Vol.2014, p.bcr2013010390
Main Authors: MacKeith, Samuel A, Soledad-Juarez, Maria, Tiberti, Liliana, Orfila, Daniel
Format: Article
Language:English
Subjects:
Adolescent
Antibiotics
Bone Diseases - complications
Bone Diseases - diagnostic imaging
Bone Diseases - pathology
Cerebrospinal fluid
Cholesteatoma - complications
Cholesteatoma - congenital
Cholesteatoma - diagnostic imaging
Cholesteatoma - pathology
Cholesterol
Cysts
Diffusion Magnetic Resonance Imaging
Female
Hearing loss
Humans
Meningitis
Meningitis, Aseptic - etiology
Petrous Bone - diagnostic imaging
Petrous Bone - pathology
Recurrence
South/Central America
Tomography, X-Ray Computed
Unusual Association of Diseases/Symptoms
White
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Summary:We describe the presentation, investigation and challenging management of a young adult with recurrent aseptic meningitis. The presence of cholesterol and triglycerides in the cerebrospinal fluid sample was recognised as a potential sign of an underlying dermoid or epidermoid cyst. We demonstrate how appropriate imaging of the skull base with diffusion-weighted imaging (DWI) MRI can help differentiate between lesions of the petrous apex, facilitating the diagnosis of a petrous apex congenital cholesteatoma/epidermoid cyst. Awareness of this unusual mode of presentation of a rare disease, as well as knowledge of key diagnostic investigations, may allow for earlier identification, treatment and reduced morbidity/mortality.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2013-010390