Pneumococcal Meningitis associated pyogenic ventriculitis: A Case Report.

Dr. Sharifah Al Muthen; Dr. Salma Albahrani; Dr. Hanan Bardwan; Dr. Amal Shilash

Volume : VIII, Issue : VII, July - 2019

Pneumococcal Meningitis associated pyogenic ventriculitis: A Case Report.

Dr. Sharifah Al Muthen, Dr. Salma Albahrani, Dr. Hanan Bardwan, Dr. Amal Shilash

Abstract :

Background: Pyogenic ventriculitis is uncommon yet fatal complication of the inflammation of the ventricular ependymal lining associated with a purulent ventricular system. The commonest organism can be gram negative organism especially if happened after neurological procedure . Case report: 63 years old male known case of Diabetes mellitus ( DM), hypertension (HTN), Parkinson diseases (PD), treated lymphoma on chemotherapy four years ago. Presented with high grade fever, delirium and seizure. Admitted to the Intensive Care Unit (ICU) as a case of septic shock. Patient intubated and started on norepinephrine, intravenous fluids, anti–epileptic ( levetiracetam ) as well as anti–meningitis antibiotic (ceftriaxone , vancomycin , ampicillin and acyclovir) plus dexamethasone. His Cereal Spinal Fluid (CSF) analysis showed: glucose 4.6 (high). CSF protein 3.3 (high), CSF WBC 4000. Blood culture showed streptococcus pneumoniae. Brain MRI was done and showed evidence of ventriculitis in form of fluid level at occipital horn of lateral ventricles, no edema no mass effect no hydrocephalus, left hypocampus hyperintensity. Diagnosis of pyogenic ventriculitis was made. Same antibiotics was continued. Repeated ain MRI on day 23 of admission showed some regression of the intraventricular fluid and interval resolution of the left hippocampus signal intensity. Finally, Patient regained full consciousness and improved dramatically and was kept for physical rehabilitation for generalized motor weakness of critical illness polyneuropathy. Conclusion: Pyogenic ventriculitis is a rare potentially lethal condition. Early diagnosis and intervention is necessary to reduce mortality and morbidity. Imaging plays an important role in establishing diagnosis in adjunct to CSF studies. Once diagnosis is established, appropriate antibiotic treatment must be started based on culture sensitivity