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[A case of nasal discharge resulting in recurrent bacterial meningitis]

Naoki Takao1, Kenzo Sakurai1, Sakae Hino1

  • 1Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine.

Rinsho Shinkeigaku = Clinical Neurology
|February 25, 2021
PubMed

Insights

Recurrent bacterial meningitis in a patient was linked to cerebrospinal fluid (CSF) leakage into the nasal passages. Endoscopic repair of this idiopathic leak resolved the recurrent infections, highlighting a crucial cause of meningitis.

Area of Science:

  • Neurology
  • Otolaryngology
  • Infectious Diseases

Background:

  • Recurrent bacterial meningitis poses a significant clinical challenge, often necessitating investigation into underlying predisposing factors.
  • Cerebrospinal fluid (CSF) otorrhea and rhinorrhea are known, albeit uncommon, causes of recurrent meningitis.

Observation:

  • A 47-year-old male presented with symptoms consistent with bacterial meningitis, including fever, headache, and meningeal irritation.
  • Diagnostic evaluation revealed characteristic CSF abnormalities indicative of bacterial meningitis.
  • During treatment, significant nasal discharge was noted, prompting further investigation.

Findings:

  • Cisternal scintigraphy confirmed the presence of CSF in the nasal discharge, identifying an idiopathic CSF leak.
  • The patient's history of recurrent bacterial meningitis was strongly correlated with this newly identified CSF leak.

Implications:

  • Idiopathic cerebrospinal fluid rhinorrhea can be a direct cause of recurrent bacterial meningitis.
  • Endoscopic surgical repair is an effective treatment for CSF leaks causing recurrent meningitis.
  • This case underscores the importance of evaluating for CSF leaks in patients with recurrent meningitis of unknown etiology.
Keywords:
bacterial meningitiscerebrospinal rhinorrheacisternal scintigraphymeningeal irritation

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