Clinical case of serous meningitis with an abnormal clinical course in an elderly woman

Background. Meningitis (MG) is an urgent medical problem. In senile people with an atypical clinical course of MG associated with concomitant diseases, the diagnosis and differential diagnosis are complicated. Purpose: to draw the attention of practitioners to the importance of timely diagnosis of MG through adequate communication with the patient, correct collection and clarification of complaints, medical history, physical examination with an assessment of not only somatic status, but also meningeal symptoms. Case report. A clinical case is given of an 87-year-old patient who was hospitalized in the therapeutic department in August. The disease had a subacute clinical onset with the appearance of cerebral syndrome (headache, dizziness of a non-systemic nature, which were joined by nausea after a few days, and after ano­ther 8 days from the onset — by vomiting and fever (at first subfebrile, and later — febrile)). There were no provoking factors and contact with an infectious patient. Medical history, features of the course of the disease for 13 days, medical care provided (at the outpatient stage, the patient visited a family doctor, and later she called an emergency medical team on her own) are described. After exa­mination by the doctors of the hospital’s admission unit and exa­minations, the woman was hospitalized in the therapeutic department with a diagnosis of hyperthermia of unknown origin. Further examination (laboratory and instrumental, including computed tomography of the brain) and clarified complaints (the presence of cephalalgia) were indications for consultation with a neurologist. According to cerebrospinal fluid analysis, serous MG was diagnosed. The patient was consulted by an infectious disease specia­list, and for further treatment, she was transferred to the infectious diseases department of another hospital (on the 4th day of her stay in the hospital). Discussion. The features of complaints, medical history and neurological status data are considered. Differential diagnosis of serous MG was carried out. The quality of medical care provided at all stages of treatment has been analyzed and assessed. Medical and ethical principles were discussed. Conclusions. An 87-year-old female patient had an atypical clinical course of serous MG. In senile people, any acute disease is often combined with concomitant somatic pathology and cognitive impairment that require attention and vigilance during consultation with a doctor and are objective factors that complicate diagnosis. The diagnosis of MG requires urgent solution to diagnostic and therapeutic and organizational issues. This clinical case provides an opportunity to improve the professional level of practitioners of various specialties (“general practice — family medicine”, “emergencies”, “therapy”, “surgery”, “neurology”, “infectious diseases”), and future neu