Autoimmune Disorders
Aseptic meningitis has also been associated with autoimmune diseases. In particular, approximately 2% to 4% percent of patients with systemic lupus erythematosus may develop aseptic meningitis. In addition to malaise, fever, and headache, aseptic meningitis due to systemic lupus erythematosus may be accompanied by myelopathy, stroke, and decreased serum complement levels. The CSF typically has a neutrophilic pleocytosis.

Malignancy
Central nervous system tumors may manifest as acute or recurrent aseptic meningitis. This may result from direct invasion of the meninges with the tumor, and there may be involvement from leukemia, lymphoma, or metastatic tumors. A chemical meningitis, caused by lipid spillage from tumors such as craniopharyngiomas or pituitary adenomas, may also occur. Aseptic meningitis due to a malignancy may cause a very low glucose level. In addition, patients may present with focal neurologic findings. Neuroimaging is warranted. The prognosis is usually poor.

Mollaret’s Meningitis
Mollaret’s meningitis is a rare syndrome of recurrent acute meningitis. The symptoms of an individual episode will resolve spontaneously in 2 to 6 days but then recur in weeks to months. The disease is most common in young adults. The CSF demonstrates a mixed lymphocytic and neutrophilic pleocytosis. Early in an attack, large fragile mononuclear cells are seen, which have been demonstrated to be monocytes. Studies have shown links with HSV 1 and 2 as well as Epstein-Barr virus.
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