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Cerebral vasculitis complicating postoperative meningitis: the role of steroids revisited

Katharine E A Darling1, Julien Niederhauser, David Bervini

  • 1Service of Infectious Diseases, Clinique Hospitalier Universitaire Vaudois, Lausanne, Switzerland. katharine.darling@chuv.ch

Swiss Medical Weekly
|November 9, 2012
PubMed

Insights

Streptococcus pneumoniae meningitis is a rare complication of trans-sphenoidal surgery. This case highlights potential dual roles of steroid treatment in this condition.

Area of Science:

  • Neurosurgery
  • Infectious Diseases
  • Neurology

Background:

  • Trans-sphenoidal surgery is a common neurosurgical procedure.
  • Meningitis is a serious infection of the central nervous system.
  • Streptococcus pneumoniae is a leading cause of bacterial meningitis.

Observation:

  • A patient developed Streptococcus pneumoniae meningitis and bacteraemia post-trans-sphenoidal surgery for a pituitary adenoma.
  • Initial treatment with ceftriaxone and dexamethasone led to improvement, but discontinuation of dexamethasone preceded rapid deterioration.
  • Cerebral MRI showed widespread ischemic lesions and signs of cerebral vasculitis.

Findings:

  • Recurrence of meningitis symptoms and neurological deficits after initial improvement.
  • Evidence of cerebral vasculitis and ischemic complications.
  • Fatal outcome despite broad-spectrum antibiotics and reintroduction of steroids.

Implications:

  • The role of corticosteroids in managing post-surgical pneumococcal meningitis requires further investigation.
  • Potential for steroids to exacerbate or ameliorate infectious complications.
  • Need for optimized prophylaxis and treatment strategies for this rare but severe complication.

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