Unusual exanthema combined with cerebral vasculitis in pneumococcal meningitis: a case report

Abstract

IntroductionBacterial meningitis is a complex, rapidly progressive disease in which neurological injury is caused in part by the causative organism and in part by the host's own inflammatory responses.Case presentationWe present the case of a two-year-old Greek girl with pneumococcal meningitis and an atypical curvilinear-like skin eruption, chronologically associated with cerebral vasculitis. A diffusion-weighted MRI scan showed lesions with restricted diffusion, reflecting local areas of immunologically mediated necrotizing vasculitis.ConclusionsAtypical presentations of bacterial meningitis may occur, and they can be accompanied by serious unexpected complications.

Beyond the Meninges: A Unique Cardiac Complication of Streptococcus pneumoniae Meningitis

“…Intriguingly, the leading candidate for the development of bradycardia in our case was meningitis causing intracranial hypertension, supported by a slight elevation of the opening pressure during lumbar puncture and MRI findings indicating CNS parenchymal and vascular involvement. This aligns with existing literature highlighting the role of CNS infections, including Pneumococcal meningitis, in causing direct cytotoxic damage, oxidative stress, and subsequent intracranial complications, such as increased intracranial pressure and neuronal injury [ 6 , 7 ]. Vasculitis and subsequent vasculopathy can be seen in up to 25% of meningitis cases [ 8 ].…”

Complicated Pneumococcal Meningitis: A Diagnostic and Therapeutic Challenge

“…The cerebral vascular involvement in pneumococcal meningitis has been modestly reported both in adults and children, with disease features ranging from hearing loss, hydrocephalus, parenchymal infarctions, cerebritis, and hemorrhages [17-21]. Systemic involvement in the form of a diffuse skin rash has been reported once previously by Theonimfi Tavladaki et al They encountered a 2-year-old child with pneumococcal meningitis, followed by immune-mediated vasculitic rashes and cerebral diffusion restriction diffusion-weighted MRI [1]. Hence, it is clear in sight that pneumococcal infection has the capacity for systemic vasculitis, as was demonstrated in our presented case as well.…”

“…Streptococcus pneumoniae meningitis may cause neurological injury by various mechanisms including meningeal inflammation, cerebral edema, necrosis, and intracranial hemorrhage. Additionally, there is evidence that cerebral infarction postbacterial meningitis may be secondary to vasculitis [1]. Vergouwen et al [2] hypothesized that diffuse cerebral intravascular coagulation is an additional explanation for cerebral infarction in patients with pneumococcal meningitis.…”