Healthy adults with Streptococcus pneumoniae meningitis and Streptococcus pneumoniae subdural abscess: two case reports and a literature review

Abstract

We present the cases of two otherwise healthy adults, one with meningitis and another with a subdural abscess, with both conditions attributable to Streptococcus pneumoniae. A 31-year-old man was admitted with a 3-day history of fever, headache, and vomiting. Physical examination revealed intermittent confusion, irritability, and neck stiffness. Cerebrospinal fluid (CSF) culture was positive for S. pneumoniae. Contrast-enhanced magnetic resonance imaging (C-MRI) revealed multiple small lesions on the bilateral frontal lobes. Intravenous ceftriaxone and vancomycin were administered, followed by intravenous moxifloxacin. His symptoms resolved within 3 months. Additionally, a 66-year-old man was admitted for acute fever with confusion, abnormal behavior, and a recent history of acute respiratory infection. Physical examination revealed confusion, neck stiffness, and a positive right Babinski sign. CSF metagenomic analysis detected S. pneumoniae. C-MRI disclosed left occipitotemporal meningoencephalitis with subdural abscesses. Intravenous ceftriaxone was administered for 3 weeks. His condition gradually improved, with resorbed lesions detected on repeat MRI. This study expanded the clinical and imaging spectra of S. pneumoniae meningitis. In healthy adults, S. pneumoniae can invade the brain, but subdural abscess is a rare neuroimaging manifestation. Early diagnosis of S. pneumoniae meningitis by high-throughput sequencing and flexible treatment strategies are necessary for satisfactory outcomes.

Acute Porphyromonas gingivalis Subdural Abscess with Brain Abscess in the Left Temporal Lobe: A Case Report and Review of Literature

“…Acute subdural abscess caused by brain abscess rupture is rare and difficult to diagnose, and is easily confused with glioma, metastatic tumor, and subdural effusion. 5 If coma, chills, high fever, convulsions, and even gongs occur suddenly on the basis of clear intracranial space occupying lesions, the possibility of brain abscess rupture should be highly suspected. 4 The disease can evolve rapidly, including decreased consciousness level, focal nerve defect, cranial nerve paralysis, vomiting, and even infectious shock.…”

Successful Management of Acute Streptococcal Meningoencephalitis Complicated by Bilateral Third-Nerve Palsies, Wall-Eyed Bilateral Internuclear Ophthalmoplegia, Blindness, and Deafness: Case Report

“…Meningoencephalitis due to Streptococcus pneumoniae may result in severe postinfection sequelae, with fatality rates of between 19 and 37%. SME occurs most commonly in association with head trauma, chronic sinusitis, and neurosurgical procedures [ 1 ].…”

“…Early diagnosis and antimicrobial intervention are essential for reducing mortality and disability associated with BME. While some case reports have demonstrated that S. pneumoniae may cause subdural abscesses, the underlying mechanism is poorly understood [ 1 , 8 ]. The authors’ bedside assessment of saccadic velocity [ 9 ] was helpful in diagnosing a bedridden, visually and hearing impaired patient with WEBINO and bilateral third-nerve palsies.…”