An unusual case of chronic meningitis.
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.


METHODS
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.
Department of General Medicine, Portsmouth Hospitals NHS Trust, Milton Rd, Portsmouth, UK. christopherboos@hotmail.com
Christopher
C
Boos
Cyrus
C
Daneshvar
Anna
A
Hinton
Matthew
M
Dawes
D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000008:administration & dosage / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D005260:Female; D006261:Headache / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D007010:Hyponatremia / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008585:Meningitis, Meningococcal / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged; D038541:Neisseria meningitidis, Serogroup B / Q000302:isolation & purification*; D013129:Spinal Puncture; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone