Bacillus cereus meningoencephalitis in an immunocompetent patient

Central nervous system (CNS) infection from Bacillus cereus (B. cereus) is rare and usually occurs in immunosuppressed patients or in a presence of invasive CNS devices. Our case reported here is a very rare case of an immunocompetent elderly patient without any CNS devices who was diagnosed with B. cereus meningoencephalitis and bacteremia. According to our patient, preceding gastrointestinal (GI) symptoms and trans-sphenoidal hypophysectomy could be the precipitating factors. A positive blood culture should not be concluded as a contamination but prompt repeating another set of blood culture for a better clinical judgment. Given its abrupt clinical course and high mortality rate, high index of suspicion for rapid detection and management is needed for a preferable clinical outcome. Empiric treatment with intravenous vancomycin is reasonable before a susceptibility result becomes available.