title: What is hiding behind bubbles of air? An unusual Streptococcus pyogenes meningitis.
abstract: Streptococcus pyogenes is a rare but aggressive cause of meningitis, which often evolves in a poor outcome with fatal consequences. Although lumbar puncture and CT scan of the brain are the gold standard of diagnosis of cerebral infections, they can have some limitations. We report and describe the clinical history and neuroimaging of a 36-year-old woman admitted to the emergency department of our hospital three days after the onset of earache and otorrhoea. When the patient developed an emergent refractory status epilepticus, the CT scan of the brain showed an unusual pneumocephalus. However, the MRI study of the brain revealed a pachymeningitis with partial thrombosis of the right transverse sinus and subdural empyema due to a S. pyogenes otitis media. Prompt diagnosis and the specific findings of the MRI allowed rapid correct treatment and thus led to a good outcome for the patient.
authors.affiliation: Department of Anaesthesia and Intensive Care, Papa Giovanni XXIII Hospital; Neurosurgery Unit, Department of Neurosurgery and Neurological Sciences, Papa Giovanni XXIII Hospital; Bergamo, Italy; Faculty of Health, Medicine, and Life Science, Maastricht University, Maastricht, The Netherlands; Department of Neuroradiology, Papa Giovanni XXIII Hospital; Section of Infectious Diseases, Department of Clinical Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gritti
authors.affiliation: Department of Anaesthesia and Intensive Care, Papa Giovanni XXIII Hospital; Neurosurgery Unit, Department of Neurosurgery and Neurological Sciences, Papa Giovanni XXIII Hospital; Bergamo, Italy; Faculty of Health, Medicine, and Life Science, Maastricht University, Maastricht, The Netherlands; Department of Neuroradiology, Papa Giovanni XXIII Hospital; Section of Infectious Diseases, Department of Clinical Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Andrea Luigi
authors.initials: AL
authors.lastname: Lanterna
authors.affiliation: Department of Anaesthesia and Intensive Care, Papa Giovanni XXIII Hospital; Neurosurgery Unit, Department of Neurosurgery and Neurological Sciences, Papa Giovanni XXIII Hospital; Bergamo, Italy; Faculty of Health, Medicine, and Life Science, Maastricht University, Maastricht, The Netherlands; Department of Neuroradiology, Papa Giovanni XXIII Hospital; Section of Infectious Diseases, Department of Clinical Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Sarnecki
authors.affiliation: Department of Anaesthesia and Intensive Care, Papa Giovanni XXIII Hospital; Neurosurgery Unit, Department of Neurosurgery and Neurological Sciences, Papa Giovanni XXIII Hospital; Bergamo, Italy; Faculty of Health, Medicine, and Life Science, Maastricht University, Maastricht, The Netherlands; Department of Neuroradiology, Papa Giovanni XXIII Hospital; Section of Infectious Diseases, Department of Clinical Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Brembilla
authors.affiliation: Department of Anaesthesia and Intensive Care, Papa Giovanni XXIII Hospital; Neurosurgery Unit, Department of Neurosurgery and Neurological Sciences, Papa Giovanni XXIII Hospital; Bergamo, Italy; Faculty of Health, Medicine, and Life Science, Maastricht University, Maastricht, The Netherlands; Department of Neuroradiology, Papa Giovanni XXIII Hospital; Section of Infectious Diseases, Department of Clinical Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Agostinis
authors.affiliation: Department of Anaesthesia and Intensive Care, Papa Giovanni XXIII Hospital; Neurosurgery Unit, Department of Neurosurgery and Neurological Sciences, Papa Giovanni XXIII Hospital; Bergamo, Italy; Faculty of Health, Medicine, and Life Science, Maastricht University, Maastricht, The Netherlands; Department of Neuroradiology, Papa Giovanni XXIII Hospital; Section of Infectious Diseases, Department of Clinical Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Rizzi
authors.affiliation: Department of Anaesthesia and Intensive Care, Papa Giovanni XXIII Hospital; Neurosurgery Unit, Department of Neurosurgery and Neurological Sciences, Papa Giovanni XXIII Hospital; Bergamo, Italy; Faculty of Health, Medicine, and Life Science, Maastricht University, Maastricht, The Netherlands; Department of Neuroradiology, Papa Giovanni XXIII Hospital; Section of Infectious Diseases, Department of Clinical Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Ferdinando Luca
authors.initials: FL
authors.lastname: Lorini
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002439:Cefotaxime / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D013354:Empyema, Subdural / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D010033:Otitis Media / Q000175:diagnosis / Q000382:microbiology; D011007:Pneumocephalus / Q000382:microbiology*; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000175:diagnosis / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000667:Ampicillin; D002439:Cefotaxime