An unusual case of chronic meningitis.

Abstract

BACKGROUND:

Chronic meningitis is defined as symptoms and signs of meningeal inflammation and persisting cerebrospinal fluid abnormalities such as elevated protein level and pleocytosis for at least one month.

CASE PRESENTATION:

A 62-year-old woman, of unremarkable past medical history, was admitted to hospital for investigation of a four-week history of vomiting, malaise an associated hyponatraemia. She had a low-grade pyrexia with normal inflammatory markers. A CT brain was unremarkable and a contrast MRI brain revealed sub-acute infarction of the right frontal cortex but with no evidence of meningeal enhancement. Due to increasing confusion and patient clinical deterioration a lumbar puncture was performed at 17 days post admission. This revealed gram-negative coccobacilli in the CSF, which was identified as Neisseria meningitidis group B. The patient made a dramatic recovery with high-dose intravenous ceftriaxone antibiotic therapy for meningococcal meningitis.

CONCLUSIONS:

1) Chronic bacterial meningitis may present highly atypically, particularly in the older adult. 2) There may be an absent or reduced febrile response, without a rise in inflammatory markers, despite a very unwell patient. 3) Early lumbar puncture is to be encouraged as it is essential to confirm the diagnosis.4) Despite a delayed diagnosis appropriate antibiotic therapy can still lead to a good outcome.

• Authors: Christopher Boos, Cyrus Daneshvar, Anna Hinton, Matthew Dawes
• Journal: BMC family practice (BMC Fam Pract) Vol. 5 Pg. 21 (Oct 06 2004) ISSN: 1471-2296 [Electronic] England
• PMID: 15469610 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Ceftriaxone

Topics

• Age Factors
• Anti-Bacterial Agents (administration & dosage, therapeutic use)
• Ceftriaxone (administration & dosage, therapeutic use)
• Diagnosis, Differential
• Female
• Headache (etiology)
• Hospitalization
• Humans
• Hyponatremia (etiology)
• Magnetic Resonance Imaging
• Meningitis, Meningococcal (cerebrospinal fluid, diagnosis, drug therapy)
• Middle Aged
• Neisseria meningitidis, Serogroup B (isolation & purification)
• Spinal Puncture
• Time Factors
• Treatment Outcome
• Vomiting (etiology)