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Case Reports in Emergency Medicine
Volume 2013, Article ID 561475, 4 pages
http://dx.doi.org/10.1155/2013/561475
Case Report

Three Cases of Neoplastic Meningitis Initially Diagnosed with Infectious Meningitis in Emergency Department

Department of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Pungnap-dong, Songpa gu, Seoul, 138-736, Republic of Korea

Received 25 March 2013; Accepted 27 May 2013

Academic Editors: M. Sand and M. T. Ventura

Copyright © 2013 Shin Ahn and Kyung Soo Lim. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Neoplastic meningitis (NM) is diagnosed by the presence of malignant cells in the cerebrospinal fluid (CSF). We report 3 patients with NM, who were misdiagnosed with infectious meningitis in emergency department (ED). Case 1. A 68-year-old man visited our ED with a 3-month history of headache. With MRI and CSF study, he was diagnosed with tuberculous meningitis. After 20 days, repeated CSF cytology showed malignant cells. His diagnosis was lung cancer with NM. Case 2. A 57-year-old man visited regional hospital ED with a 3-week history of headache and diplopia. Brain MRI was not contributory. With CSF examination, his diagnosis was aseptic meningitis. With worsening headache, he was referred to our ED. Repeated CSF showed malignant cells. His diagnosis was stomach cancer with NM. Case 3. A 75-year-old man visited a regional hospital with headache lasting for 4 months. His diagnosis was sinusitis. Persistent symptom brought him back, and he developed recurrent generalized seizures. Brain MRI showed diffuse leptomeningeal enhancement suggesting meningitis, and he was transferred to our ED. CSF exam showed malignant cells. His diagnosis was NM with unknown primary focus. When evaluating the patients with headache in ED, NM should be kept in mind as a differential diagnosis of meningitis.