{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T19:01:38Z","timestamp":1769799698597,"version":"3.49.0"},"reference-count":8,"publisher":"IMR Press","issue":"1","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br. J. Hosp. Med. (Lond)"],"abstract":"<jats:p>Aims\/Background: Increased adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) has been used as a biomarker of tuberculous meningitis and other etiologies, including viral, fungal, and neoplastic meningitis. Gout can influence inflammatory pathways, altering biochemical markers such as ADA. This report describes a unique case of varicella-zoster virus (VZV) meningitis with gout associated with elevated ADA levels. Case Presentation: A 37-year-old man presented with a one-week history of headache, fever, and chills. His medical history included gout, diagnosed three years earlier. CSF analysis from the first lumbar puncture revealed lymphocytic pleocytosis, elevated protein, mildly decreased glucose, and ADA activity of 7.4 IU\/L. The patient developed worsening headache and vomiting, prompting a second lumbar puncture. Repeat CSF analysis showed persistent lymphocytosis, mildly decreased glucose, and increased ADA activity (9.1 IU\/L). The patient also experienced an acute gout flare during hospitalization, which required antigout therapy. The subsequent CSF polymerase chain reaction (PCR) confirmed VZV meningitis. Results: The patient responded well to symptomatic treatment. Serum ADA levels were also elevated (14.7 IU\/L), likely reflecting systemic inflammation due to gout. Conclusion: Systemic inflammation, which includes the meninges and joints, had been postulated to increase protein diffusion through the vascular walls and had been associated with increased ADA activity in CSF and serum. To the best of our knowledge, this is one of the few reports on VZV meningitis and gout associated with elevated ADA levels.<\/jats:p>","DOI":"10.31083\/bjhm50384","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T07:17:52Z","timestamp":1769757472000},"source":"Crossref","is-referenced-by-count":0,"title":["Increased Cerebrospinal Fluid Adenosine Deaminase Activities in a Gouty Patient With Varicella-Zoster Virus Meningitis"],"prefix":"10.31083","volume":"87","author":[{"given":"Bon D.","family":"Ku","sequence":"first","affiliation":[{"name":"Department of Neurology, International St. Mary\u2019s Hospital, Catholic Kwandong University College of Medicine, 22711 Incheon, Republic of Korea"},{"name":"Institute for Cognitive Intervention, International St. Mary\u2019s Hospital, 22711 Incheon, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong Mo","family":"Ku","sequence":"additional","affiliation":[{"name":"Institute for Cognitive Intervention, International St. Mary\u2019s Hospital, 22711 Incheon, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji Sun","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Neurology, Misodle Geriatric Hospital, 08250 Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Mahajan M, Prasad ML, Kumar P, Kumar A, Chatterjee N, Singh S, et al. An Updated Systematic Review and Meta-Analysis for the Diagnostic Test Accuracy of Ascitic Fluid Adenosine Deaminase in Tuberculous Peritonitis. Infection & Chemotherapy. 2023; 55: 264\u2013277.","DOI":"10.3947\/ic.2023.0014"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Ye Q, Yan W. Adenosine deaminase from the cerebrospinal fluid for the diagnosis of tuberculous meningitis: A meta-analysis. Tropical Medicine & International Health. 2023; 28: 175\u2013185.","DOI":"10.1111\/tmi.13849"},{"key":"ref3","unstructured":"Yan Y, Yuan Y, Wang J, Zhang Y, Liu H, Zhang Z. Meningitis\/meningoencephalitis caused by varicella zoster virus reactivation: a retrospective single-center case series study. American Journal of Translational Research. 2022; 14: 491\u2013500."},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Carcassi A, Macr\u00ec P, Chiaroni G, Boschi S. Erythrocyte adenosine-deaminase activity in gout and hyperuricemia. Advances in Experimental Medicine and Biology. 1980; 122A: 33\u201338.","DOI":"10.1007\/978-1-4615-9140-5_6"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Pettersson T, Klockars M, Weber TH, Somer H. Diagnostic value of cerebrospinal fluid adenosine deaminase determination. Scandinavian Journal of Infectious Diseases. 1991; 23: 97\u2013100.","DOI":"10.3109\/00365549109023380"},{"key":"ref6","unstructured":"Abdolvahab A, Ali H, Mazyar Z, Anahita S, Sara K. A case of hypogammaglobulinemia with enteroviral meningoencephalitis, associated with increased adenosine deaminase in cerebrospinal fluid. Iranian Journal of Allergy, Asthma and Immunology. 2009; 8: 117\u2013119."},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"P\u00e9rez-Rodr\u00edguez MA, Varela P, Ca\u00f1izares A, Llinares P. Elevated cerebrospinal fluid adenosine deaminase levels in patients with meningitis caused by varicella-zoster virus. Enfermedades Infecciosas y Microbiologia Clinica. 2012; 30: 273\u2013274.","DOI":"10.1016\/j.eimc.2011.12.009"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Hong SI, Kim T, Jung J, Park SY, Chong YP, Lee SO, et al. Tuberculous Meningitis-Mimicking Varicella-Zoster Meningitis. Infection & Chemotherapy. 2017; 49: 123\u2013129.","DOI":"10.3947\/ic.2017.49.2.123"}],"container-title":["British Journal of Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/BJHM\/87\/1\/10.31083\/BJHM50384","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T07:18:16Z","timestamp":1769757496000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/BJHM\/87\/1\/10.31083\/BJHM50384"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":8,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1750-8460(26)00145-0"],"URL":"https:\/\/doi.org\/10.31083\/bjhm50384","relation":{},"ISSN":["1750-8460","1759-7390"],"issn-type":[{"value":"1750-8460","type":"print"},{"value":"1759-7390","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]},"article-number":"50384"}}