Imran Asad, Nazar Ullah Raja, Ejaz A Khan.
Eosinophilic meningitis - A case report and review of literature.
Infect Dis J Jan ;14(1):22-5.

A 9-year-old male presented with the complaint of fever, repetitive vomiting and severe headache for 2 days. Patient had diffuse right eye swelling mainly of the upper eyelid with lacrimation and photophobia but no redness. On general physical examination the child was anxious and irritable with obvious right eye swelling. Eye examination revealed swelling of right upper eyelid with mild redness and also showed restricted eye movements, especially upward gaze. Fundoscopy was normal. Neurological examination revealed neck stiffness but no focal neurological deficit. The cerebrospinal fluid (CSF) analysis revealed a WBC count of 360/dL with 10% neutrophils and 90% eosinophils, glucose was 83 mg/dl, and protein was 14 mg/dl. CSF smear was negative for India Ink and any larvae forms. All blood and CSF cultures were sterile for any pathogens. Computerized tomography (CT) scan of the head showed meningeal enhancement, cerebral edema. Other investigations included peripheral film showing eosinophilia with normal morphology. Toxoplasma IgM was negative and total serum IgE levels were normal. Bone marrow aspiration showed increased eosinophilic precursors but of normal morphology. A diagnosis of EM was made and the child was started on intravenous dexamethasone and oral albendazole (400 mg twice a day). Eosinophilia resolved gradually over a period of 4 months. The patient is currently asymptomatic and remains healthy.

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