Pneumococcal Meningitis Complicated by Cerebral Vasculitis, Abscess, Hydrocephalus, and Hearing Loss

Abstract

Intracranial abscesses, postinfectious vasculitis, and hydrocephalus are rare complications of Streptococcus pneumoniae (S. pneumoniae) meningitis, and to our knowledge, there have been no case reports where all these 3 complications occurred in a single patient with Streptococcus pneumoniae meningitis. Here, we report a case of a 48-year-old male who developed postinfectious vasculitis, abscess, hydrocephalus, and hearing loss after S. pneumoniae meningitis. Clinicians ought to be aware of the possible adverse outcomes of S. pneumoniae meningitis and the limitations of current treatment options.

Steroid Rebound Phenomenon as a Cause of Delayed Cerebral Vasospasm in Post-Splenectomy Pneumococcal Meningitis: A Case Report

“…For the prevention of neurological complications, dexamethasone (0.15 mg/kg/day) for four days has been recommended [ 4 ]. The steroid rebound phenomenon which occurs as dexamethasone withdrawal has been reported in pneumococcal meningitis [ 5 , 6 , 7 ]. Hydrocephalus could also occur accompanied by the rebound effect [ 7 ].…”

“…The steroid rebound phenomenon which occurs as dexamethasone withdrawal has been reported in pneumococcal meningitis [ 5 , 6 , 7 ]. Hydrocephalus could also occur accompanied by the rebound effect [ 7 ]. Its mechanism is characterized by vascular complications caused by the reactivation of the primary inflammatory response by bacterial fragments [ 5 , 6 ].…”

“…In acute pneumococcal meningitis, four days of dexamethasone is widely used to prevent neurological complications [ 4 ]. In the previous reports, delayed neurological complications have been reported after initial treatment, especially after dexamethasone withdrawal, which has been described as “steroid rebound phenomenon” [ 5 - 7 ]. Here we report a case of delayed neurological complications by usual dexamethasone use in pneumococcal meningitis as OPSI.…”