Otogenic Enterobacter cloacae meningitis complicated with pneumocephalus

Area of Science:

• Neurology
• Infectious Diseases
• Otolaryngology

Background:

• Pneumocephalus, a gas collection in the cranial cavity, is typically associated with head trauma or neurosurgery.
• Spontaneous, nontraumatic pneumocephalus is exceptionally rare.
• Community-acquired bacterial meningitis often presents with fever, mental changes, and neck stiffness.

Observation:

• A 75-year-old woman presented with symptoms indicative of meningitis.
• Brain imaging revealed pneumocephalus and fluid in the left mastoid air cells.
• Enterobacter cloacae was identified in blood and otorrhea cultures.

Findings:

• The patient was diagnosed with community-acquired bacterial meningitis, acute otitis media, and nontraumatic pneumocephalus.
• Enterobacter cloacae, an unusual pathogen for adult meningitis, was the causative agent.
• Successful treatment was achieved with a 3-week course of intravenous ceftazidime.

Implications:

• This case underscores the importance of considering Enterobacter cloacae as a potential pathogen in otogenic meningitis, especially when complicated by pneumocephalus.
• Highlights the rare occurrence of spontaneous pneumocephalus secondary to otogenic meningitis.
• Emphasizes the need for comprehensive diagnostic evaluation in patients presenting with meningitis and concurrent ear infections.