Table 3

Meningitis or meningoencephalitis with cutaneous manifestations

DisorderCutaneousNeurological
Adams-Oliver aplasia cutis congenita type IIIScalp defect at the vertex, hypoplastic nails, tortuous scalp veins, cutis marmorata telangiectatica, haemangiomaAcute bacterial meningitis from skull defect
AIDSSeborrhoea, herpes zoster, tinea corporis, S Aureus, molluscum contagiosum, Kaposi sarcoma, cryptococcosisTransient meningitis during seroconversion
Amyloidosis V (Meretoja)Cutis laxaCranial and peripheral neuropathies
Behçet’s diseaseErythema nodosum, genital and oral aphthous ulcers (not as painful as recurrent aphthae) 1-5 ulcers <10 mm, 4-14 days duration, papules, purpura, pustules, dermatographia, pyodermaChronic or recurrent meningitis, meningoencephalitis, dural sinus thrombosis
BlastomycosisHyperplastic granulomatous microabscessesVery rarely: chronic meningitis or cerebral abscess
Brill-Zinser epidemic typhusMacular rashMeningoencephalitis
Chagas diseaseRomana’s sign, inflammation of lacrimal glands, erythema multiformeEncephalitis
CoccidiomycosisErythema nodosum, draining sinus, subcutaneous cellulitisMeningitis common; sometimes from parameningeal focus in vertebral osteomyelitis
CryptococcosisMacules and nodules in only 10 -15% of affected individualsChronic meningitis
Haemophilus influenzaTypically single indurated area on face, neck, upper chest, or armAcute purulent meningitis
Histiocytic reticulosis (autosomal recessive)Purpura, jaundice, erythrodermaChronic aseptic meningitis, neuropathy
Infantile multisystem inflammatory diseaseEvanescent rash, uveitisPapilledema, optic atrophy, mental retardation, aseptic meningitis
LeptospirosisScleral conjunctival injection; maculopapular rash of trunk in 50% of cases, jaundiceSubacute meningitis
LeukaemiaErythema nodosum, Sweet’s syndrome (acute febrile neutrophilic dermatosis— painful raised red plaques commonly on face and extremities)Meningeal leukaemia is common form of relapse, especially in all
ListeriaGeneralised erythematous papules or petechiae in infants; veterinarians with tender red papules of handsSubacute meningitis
Lyme borreliosisTarget lesionEarly aseptic meningitis, polyneuropathy, delayed demyelinating disease
LymphomaErythema nodosumSubacute meningitis, cerebral or vertebral metastasis
Lymphoma, cutaneous (T cell)Scaly erythematous patches, leonine facies, poikiloderma, hypopigmented and hyperpigmented patches with atrophy and telangiectasiaSubacute meningitis, vertebral metastases
MeningococcaemiaTypically small and irregular petechiae with smudged appearance, usually on extremities and trunk; initially can mimic a viral exanthemFulminant meningitis
Murine typhusAxillary rash, macular rash of upper abdomen, shoulders, chestHeadache, encephalopathy, and nuchal rigidity without meningitis
Neurocutaneous melanosisMelanosis; large multiple pigmented skin nevi (> 20 cm), no malignant melanoma other than CNS; primarycns melanoma in over 50% of casesMeningeal enhancement secondary to melanosis of pia-arachnoid; cranial nerve palsies, Dandy Walker malformation, suprasellar calcification;
Reticulosis, familial histiocyticPurpura, jaundice, erythrodermaChronic meningitis, peripheral neuropathy
Rocky mountain spotted feverCharacteristically progressing rash begins (1) on the fourth day of fever with pink macules on wrists, ankles, forearms; (2) after 6 to 18 hours, on palms and soles, then centrally (3) after 1-3 days deep red macules; (4) after 2-4 days, non-blanching petechiaeVasculitic meningoencephalitis, choreoathetosis, deafness, hemiplegia
SarcoidosisDry skin, hypohidrosis, decreased sweating, cicatricial alopecia; acute: erythema nodosum, vesicles, maculopapular rash; chronic: lupus pernio, plaques, scars, keloidsChronic meningitis with cranial neuropathies, distal neuropathy and proximal myopathy; leukopathy, hypothalamic involvement
Sjögren’s syndromePurpura, Raynaud’s phenomenon, xerostomia, candidiasis, dental cariesAseptic meningitis, dorsal ganglionopathy with sensory ataxia, dural sinus thrombosis
SyphilisPrimary: chancre; secondary maculopapular non-pruritic scaling rash (acral), hair: patchy alopecia, condyloma lata, mucous patches, erythema multiforme, hyperpigmentation on healing; split papules, palm and sole lesionsAseptic meningitis in secondary phase; late meningovascular syphilis; tabes dorsalis
TuberculosisCutaneous tuberculosis is rare; primary tuberculosis chancre; warty tuberculosis verrucosa cutis from reinfection, postprimary lupus vulgaris, scrofuloderma, erythema nodosum, erythema multiformeChronic meningitis; Pott’s disease of vertebrae; CNS tuberculomas
Varicella-zoster (chickenpox)Vesicles with oral lesionsMeningitis with cerebellar ataxia
Vogt-Koyanagi-HaradaVitiligo type macules, poliosis and alopecia in convalescent third phaseMeningoencephalitis in first phase of illness, preceding uveitis
Yersinia pestis (bubonic plague)Erythema multiforme, bubos then petechiae and ecchymosesMeningitis can complicate all three types: bubonic, bubonic-septicaemic, pneumonic