Differential Diagnoses

Differential Diagnosis I

Viral Meningitis

Rationale:

Mr. A.K.’s description of a mild generalized throbbing headache, sensitivity to light, mild neck pain and stiffness, and malaise provides rationale for the diagnosis of viral meningitis. The positive Kernig and Brudzinski signs as well as the fever found upon examination are also indicators for viral meningitis. Mr A.K.’s recent diagnosis of leukemia provides further rationale for the diagnosis of viral meningitis as this disease can develop secondary to leukemia (McCance & Huether, 2019). Mr A.K.’s current chemotherapy regimen could be a risk factor for developing viral meningitis as it could cause depression of the immune system, making it easier for viruses to cause infection. It should be noted that different forms of meningitis have similar clinical manifestations, however, viral meningitis is the suspected diagnosis here because the symptoms are described as “mild” by Mr. A.K.. Examination of the CSF obtained from a lumbar puncture as well as CSF and blood cultures would provide a definitive diagnosis for the type of meningitis Mr. A.K. has (McCance & Huether, 2019).

Figure 1: MRI of brain with viral meningitis (Medscape, 2018)

Differential Diagnosis II

Bacterial Meningitis

Rationale:

Mr. A.K.’s description of a headache, neck stiffness and pain, and photophobia provide rationale for the diagnosis of bacterial meningitis. The clinical findings of a fever and positive Kernig and Brudzinski signs also support this diagnosis, as does the observation that he seems irritable during his examination (McCance & Huether, 2019). Mr A.K.’s current chemotherapy regimen could predispose him to a bacterial infection by suppressing the immune system. When compared to viral meningitis, the symptoms of bacterial meningitis are generally described as more severe. With that in mind, Mr. A.K. would need to be monitored to determine if his headache and photophobia increase in severity.

Figure 2: Bacterial Meningitis (UCSB, 2018)

Differential Diagnosis III

Tubercular Meningitis

Rationale:

Mr. A.K.’s report of a headache and irritability provide rationale for the diagnosis of tubercular meningitis. The fact that he has a temperature of 102 degrees F also supports this diagnosis as a low-grade fever is one of the general symptoms associated with tubercular meningitis (McCance & Huether, 2019). His report of neck stiffness could also support this diagnosis as that is a symptom seen slightly later in this form of meningitis. Mr. A.K.’s chemotherapy regimen also puts him at risk of developing this type of meningitis as it is commonly seen among immunosuppressed individuals.