Aseptic Meningitis in Oral Medicine: Exploring the Key Elements for a Challenging Diagnosis: A Review of the Literature and Two Case Reports

Stefania Leuci, Noemi Coppola, Tiziana Cantile, Elena Calabria, Laurenta Lelia Mihai and Michele Davide Mignogna
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Stefania Leuci: Oral Medicine Unit, Department of Neurosciences, Reproductive and Oral Sciences, “Federico II” University of Naples, 80131 Naples, Italy
Noemi Coppola: Oral Medicine Unit, Department of Neurosciences, Reproductive and Oral Sciences, “Federico II” University of Naples, 80131 Naples, Italy
Tiziana Cantile: Oral Medicine Unit, Department of Neurosciences, Reproductive and Oral Sciences, “Federico II” University of Naples, 80131 Naples, Italy
Elena Calabria: Oral Medicine Unit, Department of Neurosciences, Reproductive and Oral Sciences, “Federico II” University of Naples, 80131 Naples, Italy
Laurenta Lelia Mihai: Facultatea de Medicina Dentară, Universitatea Titu Maiorescu, 040051 Bucharest, Romania
Michele Davide Mignogna: Oral Medicine Unit, Department of Neurosciences, Reproductive and Oral Sciences, “Federico II” University of Naples, 80131 Naples, Italy

IJERPH, 2022, vol. 19, issue 7, 1-17

Abstract: Aseptic meningitis (AM) is a potentially severe and life-threatening disease characterized by meningeal inflammation, usually with mononuclear pleocytosis. It represents a challenging and controversial issue in medicine for multiple etiologies, classification, and difficult diagnosis in the face of nonspecific sets of signs and symptoms. In the area of interest of oral medicine, in specific clusters of patients, even if rare, the occurrence of aseptic meningitis can pose a diagnostic and management dilemma in the following potential etiologies: (i) systemic diseases with oral and meningeal involvement, which include Behçet’s disease and Sjögren syndrome; (ii) drug-induced aseptic meningitis; (iii) aseptic viral meningitis, mostly related to herpes simplex virus infection and hand, foot, and mouth disease, caused by enteroviruses. In this review, clinical manifestations, diagnostic methodologies, incidence, treatment, and prognosis for each of these clinical entities are provided. Furthermore, two illustrative case reports are described: a patient suffering from recurrent oral ulcers, in which a sudden onset of AM allows us to diagnose Neuro Behçet’s disease, and a patient affected by pemphigus vulgaris, manifesting a drug-induced AM. Exploring this complex clinical entity scenario, it is clear that an oral medicine specialist has a place on any multidisciplinary team in making such a challenging diagnosis.

Keywords: aseptic meningitis; oral medicine; Behçet’s disease; Sjögren syndrome; intravenous immunoglobulin; herpes simplex virus; hand, foot, and mouth disease; drug-induced aseptic meningitis case; Behçet’s disease related aseptic meningitis case (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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