A young man with recurrent bacterial meningitis

Abstract

A 23-year-old man presented to Rasoul-e-Akram General

Teaching Hospital with a two day history of fever,

headache, neck stiffness and vomiting. He had suffered

similar complaints when he was a child and also two years

ago. Several years ago because of a watery discharge from

his nose he was operated for a nasal polyp but the pathology

report of mass was not consistent with a polyp.

On physical examination, he had fever and neck

stiffness and a watery discharge from the right nostril, the

other systems were normal.

Laboratory investigations revealed leukocytosis with

neutrophilia and cerebral spinal fluid (CSF) sample showed

a low glucose concentration and a high protein content.

The cell count was 1250/mm3 and was predominantly

neutrophilic. Streptococcus pneumoniae grew in the CSF

culture. He was treated with ceftriaxone and vancomycin

for 14 days. A cranial CT scan was requested

Keywords

• bacterial meningitis

References

1. 1. Berliner E, Bar Meir M, Megged O. Congenital skull base defect causing recurrent bacterial meningitis. Harefuah 2012;15: 472-5.
2. 2. Dias E, Dias M. Recurrent meningitis in a child with intranasal encephalocele. J Neurosci Rural Pract 2012; 31: 102-3. doi: 10.4103/0976-3147.91981.
3. 3. Lieb G, Krauss J, Collmann H, Schrod L, Sorensen N. Recurrent bacterial meningitis. Eur J Pediatr 1996; 155: 26-30.
4. 4. Tebruegge M, Curtis N. Epidemiology, etiology, pathogenesis, and diagnosis of recurrent bacterial meningitis. Clin Microbiol Rev 2008; 21: 519-37. doi: 10. 1128/CMR.00009-08.
5. 5. Blumenfeld R, Skolnik EM. Intranasal encephaloceles. Arch Otolaryngol 1965; 82: 527.
6. 6. Wang HS, Kuo MF, Huang SC. Diagnostic approach to recurrent bacterial meningitis in children. Chang Gung Med J 2005; 28: 441- 52.
7. 7. Hristea A, Chiotan M, Tudose M, Mihalcu F. The combined value of chemoprophylaxis and pneumococcal vaccine in the prevention of recurrent pneumococcal meningitis. J Infect 1997; 34: 265-7.
8. 8. Mukerji SS, Parmar HA, Gujar S, Passamani P. Intranasal meningoencephalocele presenting as a nasal polyp-a case report. Clin Imaging 2011; 35: 309-11. doi: 10.1016/j.clinimag.2011.01.005.