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vol. 14
Letter to the Editor

Aseptic meningitis as a manifestation of a mitochondrial disorder

Josef Finsterer, Klaus W. Preidler

Arch Med Sci 2018; 14, 5: 1180–1183
Online publish date: 2016/12/29
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Myopathy is usually a disorder with muscle weakness, muscle wasting, abnormal electromyography, or abnormal muscle biopsy (electromyography – EMG) [1]. Occasionally, however, myopathy may either occur without symptoms or with only mild clinical manifestations, or even without symptoms and only elevated creatine kinase (CK) [2]. Electromyography is frequently normal or even shows neurogenic features. Muscle biopsy can be normal. If systems other than the muscle are additionally affected, myopathy is only a collateral feature in a multisystem disease or the patient suffers from a double or triple etc. trouble. Here we report a patient with a multisystem disease including myopathy, which is most likely attributable to a common cause.
The patient is a 45-year-old, Caucasian woman, height 166 cm, weight 60 kg, with a history of recurrent aseptic meningitis (no causative organism was detected) at age 24 years, at age 43 years, and at age 45 years. These episodes always started with sudden, prickly, holocranial headache, followed by > 40° fever and vomiting. After the first meningitis she developed residual headache lasting 1 year. Despite pleocytosis up to 393/3 cells, a causative agent was never detected. Each time the condition resolved completely without permanent sequelae under antibiotic treatment. Interestingly, the second aseptic meningitis was associated with aseptic pancreatitis. At age 43 years multiple cavernomas located in the frontal regions bilaterally, the pons, parahippocampally, and the occipital regions bilaterally were detected (Figure 1). From age 42 years she additionally recognised extreme fatigability and rapid exhaustion when carrying out simple daily activities. At age 43 years she experienced pontine bleeding being attributed to a cavernoma, for which she underwent gamma-knife therapy 1 month later. Shortly after gamma-knife, hyper-CK-aemia with a maximal value of 1582 U/l (n, < 170U/l) was diagnosed. From the same time, she also experienced generalised weakness and wasting of the entire musculature with a weight loss of altogether 17 kg. Though she was able to attend a fitness centre 3 times/week, she experienced muscle aches each time after exercising. For years she also had polydipsia with a fluid intake of up to 3 l/d. Her history was further noteworthy for nephrolithiasis, renal insufficiency, hyperlipidaemia, cholecystolithiasis, surgery for varicosities, haemorrhoids, recurrent syncopes as an adolescent, pneumonia as...

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