A Chain of Events Leading to Posttraumatic Subacute Meningitis

There are few reports that discuss the nebulous entity known as posttraumatic subacute meningitis. Herein, we describe a case where a male was found deceased with Streptococcus pyogenes meningitis 7 days after experiencing head trauma inflicted with a tow chain. Computed tomography scan prior to death revealed a scalp laceration with subcutaneous gas and a subdural hematoma. On autopsy, the lacerations had exposed the cranial bone, but no fracture was identified. Purulence and a pinpoint defect were observed on the dura. Histologic sections of the dura and brain showed a chronic inflammatory infiltrate, ventriculitis, and vascular involvement by bacteria. Toxicology studies were positive for methamphetamine, fentanyl, and oxycodone. Post-mortem cerebrospinal fluid and blood cultures grew S. pyogenes, complementing the gram-staining of the bacteria seen in the brain sections.While the overlying parietal bone in the area of purulence was notably thinned, a direct route of infection from the soft tissue laceration to the meninges was not grossly identified. The middle ear mastoid cells did not display purulence, and the antemortem computed tomography scan did not provide any support for an otorhinolaryngeal source for the Streptococcus meningitis. To our knowledge, this is the first published report linking head trauma to S. pyogenes meningitis.