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An unusual case of E coli meningitis in a patient with Marfan's syndrome

Raghesh Varot Kangath1, John Midturi

  • 1Scott & White Infectious Diseases Division, Texas A & M School of Medicine, Temple, TX, USA. drraghesh.vk@gmail.com

BMJ Case Reports
|March 7, 2013
PubMed

Insights

Spontaneous Escherichia coli meningitis is rare in adults. Marfan syndrome may increase meningitis risk, potentially linked to dural ectasia and meningoceles acting as bacterial entry points.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Genetics

Background:

  • Spontaneous, non-traumatic *Escherichia coli* meningitis is exceptionally rare in adult populations.
  • Marfan syndrome, a connective tissue disorder, is not widely recognized for an increased risk of meningitis.

Observation:

  • A 48-year-old woman with Marfan syndrome developed *Escherichia coli* meningitis.
  • Initial treatment involved intravenous antibiotics, with no prior imaging to investigate the meningitis etiology.
  • Negative blood cultures excluded a hematogenous route of infection.

Findings:

  • The patient presented with extensive dural ectasia and intrasacral meningoceles extending into the pelvis.
  • These anatomical abnormalities are hypothesized to have served as a portal of entry for *E. coli* from the gastrointestinal tract to the central nervous system.

Implications:

  • This case highlights a potential, previously unrecognized association between Marfan syndrome and spontaneous bacterial meningitis.
  • Dural ectasia and meningoceles in Marfan syndrome patients may warrant consideration as potential predisposing factors for meningitis.
  • Further investigation into the pathogenesis of meningitis in Marfan syndrome is recommended.

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