Streptococcus bovis very occasionally causes rarely sepsis, endocarditis, and meningitis in newborns and the elderly. We report the case of infant meningitis caused by S. bovis despite normal cerebrospinal fluid (CSF) findings at the first CSF examination. A 77-day-old boy with 21-trisomy and patent foramen ovale and seen for a high fever underwent blood examination and lumbar puncture due to toxic appearance despite a lack of meningeal signs, and was admitted. His CSF findings were normal and he was given intravenous ceftriaxone against potential bacteremia. He had systemic seizures with continuous fever for 2 days after admission and a second CSF examination. Gram-positive coccus grew from his CSF at the first examination, and CSF cells from the second lumbar puncture increased to 4060/tL (86% neutrophils), so vancomycin was added against potential enterococcal meningitis. S. bovis was finally grown from the first CSF, ceftriaxone discontinued, and intravenous ampicillin added. He recovered after 20 days of antibiotic administration. S. bovis becomes a potential pathogen for meningitis in infants, and must be considered as a cause of meningitis despite its very rarity. CSF findings at the first lumbar puncture may be normal for meningitis in newborns and infants at the first CSF examination, so we must be very careful in the diagnosis of bacterial meningitis even with normal CSF findings, and considered antibiotic treatment against potential bacterial meningitis.

Objective Warfarin is known to interact with many drugs; however, there are currently no descriptions of an interaction with linezolid in the literature. It was recently brought to our attention, however, that several warfarin-medicated patients have experienced an increase in the prothrombin time international normalized ratio (PT-INR) following the administration of linezolid. We therefore performed a retrospective survey in order to investigate the possibility of an interaction between warfarin and linezolid. Methods The survey items included age, gender, underlying disease, type of surgery, type of infectious disease, duration of linezolid administration, laboratory values and the dose of warfarin. The PT-INR was observed over time before treatment and at days 4 or 5 and 10, completion and one week after the end of concomitant therapy. Patients The subjects included six patients who were recovering from recent heart-related surgery. Results The PT-INR increased from 1.62±0.32 before concomitant linezolid administration to 3.00±0.83 at day 4 or 5 after concomitant administration (p<0.01) and significantly decreased from 1.65±0.45 at the completion of the regimen to 1.26±0.1 one week later (p<0.05). With respect to the relationship between the dose of warfarin and the PT-INR in five cases, the PT-INR increased following concomitant linezolid treatment in all cases. Conclusion Although it has been reported that linezolid does not influence the metabolism or protein binding of warfarin, our data showed potential drug interactions between warfarin and linezolid. Our data suggest that PT-INR monitoring after the completion of concomitant warfarin and linezolid therapy is important.

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