title: Spontaneous Escherichia coli meningitis associated with hemophagocytic lymphohistiocytosis.
abstract: Spontaneous Escherichia coli meningitis has not been previously reported in association with hemophagocytic lymphohistiocytosis (HLH). A previously healthy 72-year-old woman was admitted due to fever, nuchal rigidity, disturbed consciousness and splenomegaly. Anemia, thrombocytopenia and hyperferritinemia developed on the 8th day of hospitalization. Cultures of cerebrospinal fluid and blood grew E. coli. Abundant macrophages overwhelmed erythrocytes in the bone marrow aspirate, confirming the presence of hemophagocytosis. E. coli meningitis was managed with a 40-day course of antibiotic treatment. However, the severity of anemia and thrombocytopenia progressed despite intensive transfusion therapy. The patient died of HLH on the 60th day of hospitalization.
authors.affiliation: Section of Neuromuscular Diseases, Department of Neurology, Chang Gung Memorial Hospital and University Medical College, Taipei, Taiwan.
authors.forename: Kuo-Hsuan
authors.initials: KH
authors.lastname: Chang
authors.forename: Lok-Ming
authors.initials: LM
authors.lastname: Tang
authors.forename: Rong-Kuo
authors.initials: RK
authors.lastname: Lyu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D004926:Escherichia coli / Q000302:isolation & purification*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D020814:Meningitis, Escherichia coli / Q000150:complications / Q000175:diagnosis*
chemical_list: D000900:Anti-Bacterial Agents