Aseptic Meningitis Caused by Rickettsia conorii: Importance of Repeat Dosing of Antibody Titers Meningite Asséptica por Rickettsia conorii: Importância da Repetição do Doseamento dos Títulos de Anticorpos

Abstract

Rickettsia conorii infection is a rare aetiology to aseptic meningitis: inflammation of the meninges without agent isolation on cerebral spinal fluid. The authors describe the case of a 63 years old woman with headache, fever, nausea, vomiting, malaise and skin changes. On physical examination with maculopapular rash, stiff neck and positive Brudzinski´s sign. IgM antibodies against Rickettsia conorii were negative and IgG were positive (+). Lumbar puncture was performed with clear cerebrospinal fluid (CSF), pleocytosis with 72% neutrophil, 0.76 g/dL of proteins and 59.0 mg/dL of glucose (with 0.45 ratio CSF/plasma). The woman was hospitalized with presumable meningitis. Treatment to rickettsiosis was empirically initiated with doxycycline and a clinical improvement was registered. A second dosing of anti-Rickettsia IgM antibody was positive (++) as well as the IgG (+++). The patient was discharged after complete resolution of symptoms without sequelae.

Received: 12/10/2016 - Accepted: 25/10/2016