Intraventricular empyema caused by Neisseria meningitidis

Abstract

Meningitis is defined as an inflammation of the protective covering of brain and spinal cord collectively called as meninges. Meningeal infection can be complicated by intraventricular empyema. There are 9 cases of intraventricular empyema described in the literature out of which only three are described to be caused by Neisseria meningitidis. We report the fourth rare case.A 61-year-old female with past medical history of diabetes and hypertension presented with the chief complaint of fever with chills and headache of 1-day duration. CT head did not reveal any acute abnormalities. Lumbar puncture was obtained and empiric IV antimicrobial agents were started. CSF analysis showed gram negative diplococci with culture growing Neisseria meningitidis suggesting meningococcal meningitis. Due to persistent headache and lethargy after complicated meningitis was suspected and MRI of brain was obtained which reflected a diagnosis of intraventricular empyema.Pyogenic ventriculitis also known as intraventricular empyema or ependymitis, is a defined as an inflammation of the ependymal lining of the cerebral ventricular system and is characterized by the presence of suppurative fluid in the ventricles. It is a health care associated complication and is often confused with meningitis due to the similar presentation. Therefore, persistent symptoms despite optimal antimicrobial therapy (therapeutic failure) should alarm the presence of pyogenic ventriculitis.This is the fourth case of intraventricular empyema reported secondary to Neisseria meningitidis. Our case reiterates that clinicians should maintain an index of suspicion for complicated meningitis in patients not responding to standard antimicrobial therapy.

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

“…[ 67 ] 2017 Switzerland A 55-year-old woman with a history of high fever was admitted to the centre and hospitalized with the diagnosis of bronchopneumonia. Transthoracic echocardiography showed severe aortic valve regurgitation with a mobile vegetation and abscess cavity underneath the left main stem PCR test Patient presented with endocarditis Bajaj et al 2019 [ 68 ] Not explicitly stated. Year of publication was 2019 USA A 61-year-old woman with past medical history of diabetes and hypertension presented with fever, chills and headache of 1 day duration Lab confirmed This was the fourth case of intraventricular empyema reported secondary to Neisseria meningitidis Keeley et al 2018 [ 69 ] 2018 UK A 74-year-old Caucasian woman with no history of immunosuppression or rheumatological disease, but with a history of paroxysmal atrial fibrillation for which she was taking flecainide but no anticoagulation, was admitted following a Baltic cruise holiday PCR confirmed Patient presented as myopericarditis Walayat et al 2018 [ 70 ] 2018 USA The case of a 72-year-old man with a past medical history of severe COPD, obstructive sleep apnoea, and stage I lung cancer status post-stereotactic body radiation therapy 1 year ago PCR confirmed Patient presented with a 6-day history of productive cough with yellowish sputum, shortness of breath, extreme myalgia, and fatigue Romero-Gomez et al 2012 [ 71 ] 2011 Spain A 94-year-old man sought medical care for left-sided chest pain and difficulty in breathing that began 1 day before admission.…”

Community-Acquired Meningitis Complicated by Pyogenic Ventriculitis: A Case Report

“…Pyogenic ventriculitis is an uncommon infection involving the ependymal lining of the ventricles of the brain [1]. It is also known as ependymitis, pyocephalus, or intraventricular empyema [1].…”

Recurrent primary pyogenic ventriculitis in an adult woman: a case report

“…We observed that most cases of primary pyogenic ventriculitis occur in children and neonates. Only 9 adult cases have been documented: 6 in a 2017 review [1] and 3 more since then [2][3][4]. There are no reports of recurrent primary pyogenic ventriculitis.…”

“…Author details 1 Department of Clinical Nutrition, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian, China. 2 Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian, China. 3 Department of Medical Imaging, the 910th hospital of the People's Liberation Army, Quanzhou 362000, Fujian, China.…”