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Persistent neutrophilic meningitis in an immunocompetent patient after basilar skull fracture: case report. | LitMetric

Persistent neutrophilic meningitis in an immunocompetent patient after basilar skull fracture: case report.

BMC Infect Dis

Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA.

Published: May 2011

AI Article Synopsis

Article Abstract

Background: Persistent neutrophilic meningitis is an unusual form of chronic meningitis that is defined as clinical meningitis with a neutrophilic pleocytosis that persists for greater than 7 days despite empiric antimicrobial therapy. Although numerous disease processes can cause this syndrome, the majority of cases are due to opportunistic pathogens infecting immunocompromised hosts.

Case Presentation: A 47 year-old female presented after basilar skull fracture with persistent neutrophilic meningitis unresponsive to empiric broad-spectrum antibiotics. After more than weeks of intensive therapy, 4 hospitalizations and 3 relapses, Nocardia cyriacigeorgica was identified from cerebral spinal fluid. Induction therapy was begun with Ceftriaxone and trimethoprim-sulfamethoxazole (TMP-SMX) for 6 weeks followed by therapy with TMP-SMX and doxycycline for one year. The patient made a complete recovery without sequelae.

Conclusions: Due to the difficulty in obtaining a microbiologic diagnosis, appropriate treatment in cases of persistent neutrophilic meningitis is often delayed leading to morbidity, This case highlights a number of the unique features of Nocardia meningitis and the importance of considering Nocardia infection as a cause of persistent neutrophilic meningitis even in immunocompetent patients.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115869PMC
http://dx.doi.org/10.1186/1471-2334-11-136DOI Listing

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