Meningitis retention syndrome - Case report

Background: Urinary retention is a common presenting complaint in Emergency Department. Meningitis can be an unusual cause for this. This combination is referred to as Meningitis Retention Syndrome (MRS). We present 2 cases of MRS diagnosed in A&E, Alkhor. Case 1: A 43-year-old male presented to ED with low grade fever, head ache of 10 days and dysuria of 2 days duration. Examination was unremarkable except for palpable bladder. Examination of CNS was normal. He was discharge on antibiotic after catheterisation of urinary bladder. He was readmitted to ED after few days with worsening of symptoms. Physical examination was unremarkable. CT head (contrast) showed meningeal enhancements and CSF study showed lymphocytic pleocytosis. He was initiated on anti-tubercular treatment (ATT). Patient improved and was discharged. Case 2: A 42-year-old male presented to ED with fever and dysuria. He was managed as a case of urinary tract infection. He was readmitted to ED with fever and urinary retention. Physical examination was unremarkable except for temperature 38.5°C. Blood test and urinalysis were normal. He was discharged on medication. 2 days later he was admitted with altered sensorium high grade fever and clinical features of meningitis. CSF study showed lymphocytic pleocytosis. Patient was initiated on ATT. Patient had a prolonged and stormy hospital stay and later improved. Discussion: Meningitis Retention syndrome is thought to be a very minute form of acute disseminated encephalomyelopathy. Urinary retention might reflect acute shock phase of this disorder. Most of the previously reported cases were due to aseptic meningitis but here we report two cases of MRS due to tuberculous meningitis Acute urinary retention can provide a critical clue to the diagnosis of meningitis as a cause of fever of unknown origin.