7.3.2 Headache attributed to aseptic (non-infectious) meningitis

Identification: Sex/Age: Female, 28 years. History: Systemic lupus erythematosus (SLE) under treatment with azathioprine and prednisone. Recent medication: Introduction of ibuprofen 1 week ago for arthralgias. History of Present Illness (HPI): Main symptom: Intense and diffuse headache for 2 days. Pain characteristics: Onset: Subacute, progressive. Intensity: 9/10, continuous. Aggravation: Worsens with head movements. Associated symptoms: Low-grade fever (37.8°C). Neck stiffness. Photophobia and phonophobia. Nausea without vomiting. Physical/Neurological Examination: Meningeal signs present: Neck stiffness (+), positive Kernig's sign. No focal deficit: Normal muscle strength, reflexes, and sensation. Consciousness preserved, but with mild irritability. Complementary Examinations: Cerebrospinal fluid (CSF): Appearance: Clear. Cytometry: Lymphocytic pleocytosis (120 cells/mm³). Biochemistry: Elevated proteins (80 mg/dL), normal glucose. Bacterial and viral cultures: Negative. PCR for common viruses (HSV, enteroviruses): Negative. Cranial MRI: No parenchymal changes or contrast-enhancing meningitis. Laboratory: Mild leukocytosis (11,000/mm³), elevated CRP.