physical exam in viral meningitis

Q: 29 years old male is admitted to ICU with mental status change. There is a high suspicion of viral meningitis. Physical exam showed oropharyngeal thrush accompanied with cervical lymphadenopathy. Which of the following is most likely cause? (select one)

A) enterovirus

B) primary HIV

C) mumps 

D) HSV-2 

E) west Nile virus 

Answer: B

The objective of this question is to highlight the importance of a physical exam in diagnosis. Besides classic signs of meningitis, there are various other clues that may help to determine the exact cause of the diagnosis. 

Oropharyngeal thrush with cervical lymphadenopathy is usually seen with primary HIV (choice B). 

Enteroviral meningitis is frequently accompanied by a diffuse maculopapular exanthem (choice A). 

Mumps can be confused with symptoms of primary HIV but it is mostly present with

parotitis and history of unvaccinated (choice C). 

As expected HSV-2 usually has vesicular and ulcerative genital lesions (choice D). 

West Nile virus meningitis has a classic symptom of flaccid paralysis, mostly asymmetric (choice E).

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#physical exam

References:

1. Kohil A, Jemmieh S, Smatti MK, Yassine HM. Viral meningitis: an overview. Arch Virol. 2021;166(2):335-345. doi:10.1007/s00705-020-04891-1. 

2. Ihekwaba UK, Kudesia G, McKendrick MW. Clinical features of viral meningitis in adults: significant differences in cerebrospinal fluid findings among herpes simplex virus, varicella zoster virus, and enterovirus infections. Clin Infect Dis. 2008 Sep 15;47(6):783-9. doi: 10.1086/591129. PMID: 18680414.