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Case Reports
. 2021 Jul 22;15(1):390.
doi: 10.1186/s13256-021-02956-6.

Asymptomatic meningitis diagnosed by positron emission tomography in a patient with syndrome of inappropriate antidiuretic hormone secretion: a case report

Masanori Hasebe  1 , Jun Shirakawa  2   3 , Daisuke Miyashita  1 , Rieko Kunishita  1 , Mayu Kyohara  1 , Tomoko Okuyama  1 , Yu Togashi  1 , Yasuo Terauchi  1
Affiliations
Case Reports

Asymptomatic meningitis diagnosed by positron emission tomography in a patient with syndrome of inappropriate antidiuretic hormone secretion: a case report

Masanori Hasebe et al. J Med Case Rep. .

Abstract

Background: Syndrome of inappropriate antidiuretic hormone secretion can be caused by arginine-vasopressin-producing tumors or enhanced arginine vasopressin secretion from the posterior pituitary gland due to central nervous system disorders and intrathoracic diseases.

Case presentation: A 53-year-old Asian man was hospitalized with complaints of tremor and hiccups. Laboratory examination revealed findings suggestive of hypotonic hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion. The patient did not complain of headache or photophobia, and showed no signs of meningeal irritation. Positron emission tomography-computed tomography revealed 18F-fluoro-deoxy-glucose accumulation along the cervical spinal cord, based on which the patient was diagnosed as having aseptic meningitis. The hyponatremia was treated successfully by fluid restriction, and optimum plasma sodium concentration was maintained by tolvaptan administration.

Conclusions: This case underscores the need to consider the possibility of mild meningitis as the cause of syndrome of inappropriate antidiuretic hormone secretion in patients without other identifiable cause.

Keywords: Aseptic meningitis; Hyponatremia; SIADH; Vasopressin.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
18F-FDG PET-CT imaging. The arrow indicates the abnormal accumulation of FDG along cervical cord
Fig. 2
Fig. 2
Clinical course. The arrow indicates fluid restriction to 800 mL/day. The serum sodium level improved after the fluid restriction and remained stable after the start of tolvaptan administration. Baclofen 15 mg/day and clonazepam 1 mg/day were used as symptomatic treatments for the hiccups and tremor; the dose of clonazepam was subsequently increased to 2 mg/day
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