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Persistent neutrophilic meningitis in an immunocompetent patient after basilar skull fracture: case report

Jaime S Green1, Shira R Abeles, Daniel Z Uslan

  • 1Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA. jsgreen@ucsd.edu

BMC Infectious Diseases
|May 21, 2011
PubMed
Abstract

Insights

Persistent neutrophilic meningitis, often caused by opportunistic pathogens, can be challenging to diagnose. This case highlights Nocardia cyriacigeorgica as a treatable cause, even in immunocompetent individuals.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Microbiology

Background:

  • Persistent neutrophilic meningitis is characterized by neutrophilic pleocytosis lasting over 7 days despite antibiotics.
  • Opportunistic pathogens are common causes, particularly in immunocompromised patients.

Observation:

  • A 47-year-old female presented with persistent neutrophilic meningitis following a basilar skull fracture.
  • The condition was unresponsive to broad-spectrum antibiotics, leading to multiple hospitalizations and relapses.
  • Nocardia cyriacigeorgica was eventually identified in the cerebrospinal fluid.

Findings:

  • Successful treatment involved a combination of Ceftriaxone and trimethoprim-sulfamethoxazole (TMP-SMX), followed by long-term TMP-SMX and doxycycline.
  • The patient achieved a complete recovery without any lasting neurological deficits.

Implications:

  • Delayed diagnosis of persistent neutrophilic meningitis can lead to significant morbidity.
  • Nocardia meningitis should be considered in persistent neutrophilic meningitis cases, even in immunocompetent patients.
  • Early and accurate microbiologic diagnosis is crucial for effective treatment and improved patient outcomes.

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