[Implication of dexamethasone adjunctive therapy after the onset of cerebral vasculitis in Streptococcus pneumoniae meningitis].
Few adverse effects have been reported with adjunctive dexamethasone treatment in pneumococcal meningitis. Nevertheless, we report a case of cerebral vasculitis. A 49-year-old man was admitted for fever and altered mental status. Lumbar puncture revealed a high inflammatory response and Streptococcus pneumoniae was identified by culture. Antibacterial therapy and adjunctive dexamethasone treatment were initiated as recommended. The immediate outcome was favorable but due to the onset of focal cerebral abnormalities, a CT scan was performed on the ninth day showing cerebral vasculitis. The patient died on the thirteenth day despite antibacterial therapy and resuscitation. In our case, a secondary neurological worsening appeared when adjunctive dexamethasone treatment was stopped suggesting a rebound effect. Observation of similar cases may lead to modifying adjunctive dexamethasone treatment protocol in bacterial meningitis.
Lefebvre
N
N
Service de Réanimation Médicale, Centre Hospitalier de Mulhouse, 20, rue du Docteur-René-Laennec, 68070 Mulhouse cedex 01, France. n.lefebvre@yahoo.fr
Carre
A-C
AC
Delabranche
X
X
Guiot
P
P
Mootien
Y
Y
D000658:Amoxicillin / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001170:Arthritis, Infectious / Q000150:complications; D001929:Brain Edema / Q000139:chemically induced / Q000209:etiology; D002439:Cefotaxime / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003128:Coma / Q000209:etiology; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D004630:Emergencies; D004677:Encephalocele / Q000139:chemically induced / Q000209:etiology; D017809:Fatal Outcome; D005334:Fever / Q000209:etiology; D006801:Humans; D007719:Knee Joint / Q000382:microbiology; D008297:Male; D008586:Meningitis, Pneumococcal / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D013375:Substance Withdrawal Syndrome / Q000209:etiology*; D014640:Vancomycin / Q000627:therapeutic use; D020293:Vasculitis, Central Nervous System / Q000188:drug therapy / Q000209:etiology*
D000893:Anti-Inflammatory Agents; D014640:Vancomycin; D003907:Dexamethasone; D000658:Amoxicillin; D002439:Cefotaxime