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Viral Meningitis — RACP Adult Medicine MCQ

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EasyInfectious DiseasesViral MeningitisRACP Adult Medicine

A 30-year-old woman presents with headache and mild neck stiffness for 3 days. CSF: Opening pressure 18 cmH₂O, WCC 250 cells/μL (98% lymphocytes), protein 0.8 g/L, glucose 3.2 mmol/L (serum 5.5 mmol/L). PCR for enterovirus is positive. What is the most likely CSF diagnosis?

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Correct answer: DViral meningitis

Lymphocytic predominant CSF with mildly elevated protein, normal glucose (CSF:serum ratio >0.5), and positive enterovirus PCR is viral meningitis. Enteroviruses are the commonest cause. Management is supportive. Importantly, early bacterial meningitis can also show lymphocyte predominance, so clinical context and serial CSF may be needed.

Reference: eTG Antibiotic – 2025 – Viral Meningitis