Unmasking Aseptic Meningitis in Pregnancy Diagnostic Hurdles and Clinical Lessons from a Rare Case

Introduction

Aseptic meningitis is a rare but concerning complication during pregnancy. This clinical case study published in Clinical Journal of Obstetrics and Gynecology explores how atypical symptoms delayed diagnosis and what this means for obstetric care providers.
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A Misleading Headache

• Patient: 36-year-old pediatrician, 31+5 weeks pregnant.
• Complaint: Severe headache, no fever or neck stiffness initially.
• Initial Findings: Normal vital signs, no neurological abnormalities.
• Differentials Considered: Migraine, cerebral venous thrombosis, intracranial hemorrhage, and meningitis.

Despite lacking the classic meningitis triad, worsening symptoms including photophobia and pyrexia led to advanced neurological assessment.

Diagnostic Pathway & Key Findings

• MRI Result: Revealed a 2cm arachnoid cyst (unrelated).
• Lumbar Puncture: Elevated CSF WBC count (1030/uL), lymphocyte predominance (75%).
• PCR Diagnosis: Confirmed enterovirus meningitis.
• Treatment: Ceftriaxone + acyclovir; symptomatic relief by day 3; discharged day 4.

Read the full study at: https://doi.org/10.29328/journal.cjog.1001130

Integration of External Medical Sources

The Centers for Disease Control and Prevention (CDC) emphasizes that while enteroviruses are common in children, exposure during pregnancy may result in rare neurological infections such as aseptic meningitis. CDC guidance highlights the importance of monitoring symptoms like headache, fever, and photophobia, particularly for healthcare workers in pediatric environments.

Clinical Implications & Learning Points

• Classic triad not always present: Less than half of adult meningitis cases exhibit fever, neck stiffness, and altered mental status.
• Pregnancy-related immune modulation can increase susceptibility to viral infections.
• Early specialist referral and multidisciplinary approach improves outcomes in atypical presentations.
• Diagnostic Tools: MRI preferred over CT in pregnancy; lumbar puncture is essential despite being invasive.
• Virology: Enterovirus, HSV, and VZV are common viral meningitis agents in pregnant women.

Prognosis & Outcomes

The patient recovered without maternal or fetal complications and delivered at full term. Her arachnoid cyst is under follow-up with neurology.

Further Reading and Resources

• Learn more about maternal-fetal infections and how they impact obstetric care.
• Stay updated with clinical case reports at Obstetric & Gynecology Journal.

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