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JAMA Ophthalmology Clinical Challenge
July 6, 2017

A Teenage Girl With Aseptic Meningitis and Unilateral Blurry Vision

Author Affiliations
  • 1Mayo Clinic Department of Ophthalmology, Rochester, Minnesota
JAMA Ophthalmol. Published online July 6, 2017. doi:10.1001/jamaophthalmol.2017.0747

A 14-year-old girl presented to the emergency department after experiencing 2 weeks of fever, malaise, photophobia, phonophobia, headache, nausea, vomiting, and neck stiffness. Computed tomography scan results of her head did not reveal any acute intracranial pathology. Her systemic inflammatory markers were elevated, including a left-shifted leukocytosis with a white blood cell count of 15 200 μL (normal values, 4100-8900 μL) (to convert to × 109/L, multiply by 0.001), a platelet count of 458 × 103 μL (150-450 × 103 μL) (to convert to × 109/L, multiply by 1.0), and a C-reactive protein level of 17.3 mg/L (<8.0 mg/L) (to convert to nanomoles per liter, multiply by 9.524). Cerebrospinal fluid studies were suggestive of aseptic meningitis: elevated protein levels (0.139 g/dL, 0-0.035 g/dL) (to convert to grams per liter, multiply by 10.0), increased neutrophils (32%, 2% ± 4%), normal opening pressure, and normal glucose levels.

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