DISCUSSION
In this case, we suspected meningitis based on a positive ocular globe compression sign, and made a diagnosis of aseptic meningitis by repeat LP. A longer clinical course (7–18 days) characterizes enteroviral meningitis in comparison to other types of viral meningitis,1 which was consistent with this case. A previous study reported the sensitivity and specificity (respectively) of meningeal tests as follows: nuchal rigidity (46.1%, 71.3%), jolt accentuation test (52.4%, 71.1%), Kernig’s sign (22.9%, 91.2%), and Brudzinski’s sign (27.5%, 88.8%).2 The ocular globe compression sign (applying digital pressure to both eyeballs and observing the presence and degree of pain reaction to the stimulus) was proposed in 2002,3 and has a sensitivity and specificity of 34.5% and 78.6%, respectively.4 In our patient, all the meningeal signs, except for the ocular globe compression sign, were negative. Moreover, the return to negativity of the ocular globe compression sign coincided with an improvement in his symptoms. Further studies are needed to clarify the clinical significance of the ocular globe compression sign in the diagnosis of aseptic meningitis and its relationship with the clinical course. In a previous study of patients with suspected meningitis and initial negative CSF findings, 88% had an elevated CSF cell count on repeat LP.5 However, the sensitivity and specificity of repeat CSF tests in viral meningitis are unknown. PCR testing for viruses is not routinely available; therefore, clinical signs are useful in the diagnosis of aseptic meningitis. A diagnosis of meningitis should not be excluded if the first LP is normal. It is important to perform repeated CSF and meningeal sign tests to reduce the risk of missing the diagnosis.