title: Persisting vasculitis after pneumococcal meningitis.
abstract: BACKGROUND
  Bacterial meningitis is associated with a high mortality and a high incidence of neurological sequelae. Parainfectious vasculitis leading to ischemic brain damage is a known complication of bacterial meningitis but its treatment is uncertain.
  
  
  RESULTS
  We report the case of a 53-year-old man with pneumococcal meningitis who developed numerous ischemic lesions in the brainstem and basal ganglia caused by parainfectious vasculitis. Clinical and radiological improvement was observed after delayed corticosteroid initiation. Symptomatic vasculitis relapsed after steroid withdrawal and stabilized after reintroduction of the immunosuppressive therapy. Although the cerebrospinal fluid (CSF) contained high levels of MMP-9 at the time of symptomatic vasculitis, a significant decrease of the enzyme accompanied the introduction of corticotherapy and the regression of vasculitic symptoms. No relation between the level of MMP-9 and the white blood cell count in CSF could be found.
  
  
  CONCLUSIONS
  Parainfectious vasculitis may respond to late corticosteroid treatment. MMP-9 level in CSF may be a marker of vasculitic complication in bacterial meningitis.
authors.affiliation: Department of Clinical Neuroscience and Dermatology, Geneva University Hospital, and Geneva Medical School, CH-1211 Geneva, Switzerland.
authors.forename: Deborah
authors.initials: D
authors.lastname: Pugin
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Copin
authors.forename: Marie-Christelle
authors.initials: MC
authors.lastname: Goodyear
authors.forename: Theodor
authors.initials: T
authors.lastname: Landis
authors.forename: Yvan
authors.initials: Y
authors.lastname: Gasche
mesh_terms: D003520:Cyclophosphamide / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D020782:Matrix Metalloproteinases / Q000378:metabolism; D008586:Meningitis, Pneumococcal / Q000188:drug therapy / Q000201:enzymology / Q000473:pathology*; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D020293:Vasculitis, Central Nervous System / Q000188:drug therapy / Q000201:enzymology / Q000382:microbiology*
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone; D020782:Matrix Metalloproteinases