Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2011

Open Access 01-12-2011 | Case report

Unusual exanthema combined with cerebral vasculitis in pneumococcal meningitis: a case report

Authors: Theonimfi Tavladaki, Anna-Maria Spanaki, Stavroula Ilia, Elisabeth Geromarkaki, Maria Raissaki, George Briassoulis

Published in: Journal of Medical Case Reports | Issue 1/2011

Login to get access

Abstract

Introduction

Bacterial meningitis is a complex, rapidly progressive disease in which neurological injury is caused in part by the causative organism and in part by the host's own inflammatory responses.

Case presentation

We present the case of a two-year-old Greek girl with pneumococcal meningitis and an atypical curvilinear-like skin eruption, chronologically associated with cerebral vasculitis. A diffusion-weighted MRI scan showed lesions with restricted diffusion, reflecting local areas of immunologically mediated necrotizing vasculitis.

Conclusions

Atypical presentations of bacterial meningitis may occur, and they can be accompanied by serious unexpected complications.
Appendix
Available only for authorised users
Literature
1.
go back to reference Vergouwen MD, Schut ES, Troost D, van de Beek D: Diffuse cerebral intravascular coagulation and cerebral infarction in pneumococcal meningitis. Neurocrit Care. 2010, 13: 217-227. 10.1007/s12028-010-9387-5.CrossRefPubMed Vergouwen MD, Schut ES, Troost D, van de Beek D: Diffuse cerebral intravascular coagulation and cerebral infarction in pneumococcal meningitis. Neurocrit Care. 2010, 13: 217-227. 10.1007/s12028-010-9387-5.CrossRefPubMed
2.
go back to reference Scheld WM, Koedel U, Nathan B, Pfister H-W: Pathophysiology of bacterial meningitis: mechanism(s) of neuronal injury. J Infect Dis. 2002, 186 (Suppl 2): S225-233.CrossRefPubMed Scheld WM, Koedel U, Nathan B, Pfister H-W: Pathophysiology of bacterial meningitis: mechanism(s) of neuronal injury. J Infect Dis. 2002, 186 (Suppl 2): S225-233.CrossRefPubMed
3.
go back to reference Vestrheim DF, Høiby EA, Bergsaker MR, Rønning K, Aaberge IS, Caugant DA: Indirect effect of conjugate pneumococcal vaccination in a 2+1 dose schedule. Vaccine. 2010, 28: 2214-2221. 10.1016/j.vaccine.2009.12.054.CrossRefPubMed Vestrheim DF, Høiby EA, Bergsaker MR, Rønning K, Aaberge IS, Caugant DA: Indirect effect of conjugate pneumococcal vaccination in a 2+1 dose schedule. Vaccine. 2010, 28: 2214-2221. 10.1016/j.vaccine.2009.12.054.CrossRefPubMed
4.
go back to reference Harboe ZB, Valentiner-Branth P, Benfield TL, Christensen JJ, Andersen PH, Howitz M, Krogfelt KA, Lambertsen L, Konradsen HB: Early effectiveness of heptavalent conjugate pneumococcal vaccination on invasive pneumococcal disease after the introduction in the Danish Childhood Immunization Programme. Vaccine. 2010, 28: 2642-2647. 10.1016/j.vaccine.2010.01.017.CrossRefPubMed Harboe ZB, Valentiner-Branth P, Benfield TL, Christensen JJ, Andersen PH, Howitz M, Krogfelt KA, Lambertsen L, Konradsen HB: Early effectiveness of heptavalent conjugate pneumococcal vaccination on invasive pneumococcal disease after the introduction in the Danish Childhood Immunization Programme. Vaccine. 2010, 28: 2642-2647. 10.1016/j.vaccine.2010.01.017.CrossRefPubMed
5.
go back to reference Fisher JD: Insidious presentation of pediatric pneumococcal meningitis: alive and well in the post vaccine era. Am J Emerg Med. 2009, 27: 1173.e5-7. 10.1016/j.ajem.2009.01.015.CrossRef Fisher JD: Insidious presentation of pediatric pneumococcal meningitis: alive and well in the post vaccine era. Am J Emerg Med. 2009, 27: 1173.e5-7. 10.1016/j.ajem.2009.01.015.CrossRef
6.
go back to reference Sundelöf B, Gnarpe H, Gnarpe J: An unusual manifestation of Chlamydia pneumoniae infection: meningitis, hepatitis, iritis and atypical erythema nodosum. Scand J Infect Dis. 1993, 25: 259-261. 10.3109/00365549309008494.CrossRefPubMed Sundelöf B, Gnarpe H, Gnarpe J: An unusual manifestation of Chlamydia pneumoniae infection: meningitis, hepatitis, iritis and atypical erythema nodosum. Scand J Infect Dis. 1993, 25: 259-261. 10.3109/00365549309008494.CrossRefPubMed
7.
go back to reference Karanika M, Vasilopoulou VA, Katsioulis AT, Papastergiou P, Theodoridou MN, Hadjichristodoulou CS: Diagnostic clinical and laboratory findings in response to predetermining bacterial pathogen: data from the Meningitis Registry. PLoS One. 2009, 4: e6426-10.1371/journal.pone.0006426.CrossRefPubMedPubMedCentral Karanika M, Vasilopoulou VA, Katsioulis AT, Papastergiou P, Theodoridou MN, Hadjichristodoulou CS: Diagnostic clinical and laboratory findings in response to predetermining bacterial pathogen: data from the Meningitis Registry. PLoS One. 2009, 4: e6426-10.1371/journal.pone.0006426.CrossRefPubMedPubMedCentral
8.
go back to reference Kutz JW, Simon LM, Chennupati SK, Giannoni CM, Manolidis S: Clinical predictors for hearing loss in children with bacterial meningitis. Arch Otolaryngol Head Neck Surg. 2006, 132: 941-945. 10.1001/archotol.132.9.941.CrossRefPubMed Kutz JW, Simon LM, Chennupati SK, Giannoni CM, Manolidis S: Clinical predictors for hearing loss in children with bacterial meningitis. Arch Otolaryngol Head Neck Surg. 2006, 132: 941-945. 10.1001/archotol.132.9.941.CrossRefPubMed
9.
go back to reference Worsøe L, Cayé-Thomasen P, Brandt CT, Thomsen J, Østergaard C: Factors associated with the occurrence of hearing loss after pneumococcal meningitis. Clin Infect Dis. 2010, 51: 917-924. 10.1086/656409.CrossRefPubMed Worsøe L, Cayé-Thomasen P, Brandt CT, Thomsen J, Østergaard C: Factors associated with the occurrence of hearing loss after pneumococcal meningitis. Clin Infect Dis. 2010, 51: 917-924. 10.1086/656409.CrossRefPubMed
10.
go back to reference Jorens PG, Parizel PM, Demey HE, Smets K, Jadoul K, Verbeek MM, Wevers RA, Cras P: Meningoencephalitis caused by Streptococcus pneumoniae: a diagnostic and therapeutic challenge. Diagnosis with diffusion-weighted MRI leading to treatment with corticosteroids. Neuroradiology. 2005, 47: 758-764. 10.1007/s00234-005-1423-3.CrossRefPubMed Jorens PG, Parizel PM, Demey HE, Smets K, Jadoul K, Verbeek MM, Wevers RA, Cras P: Meningoencephalitis caused by Streptococcus pneumoniae: a diagnostic and therapeutic challenge. Diagnosis with diffusion-weighted MRI leading to treatment with corticosteroids. Neuroradiology. 2005, 47: 758-764. 10.1007/s00234-005-1423-3.CrossRefPubMed
11.
go back to reference Appenzeller S, Faria AV, Zanardi VA, Fernandes SR, Costallat LT, Cendes F: Vascular involvement of the central nervous system and systemic diseases: etiologies and MRI findings. Rheumatol Int. 2008, 28: 1229-1237. 10.1007/s00296-008-0647-z.CrossRefPubMed Appenzeller S, Faria AV, Zanardi VA, Fernandes SR, Costallat LT, Cendes F: Vascular involvement of the central nervous system and systemic diseases: etiologies and MRI findings. Rheumatol Int. 2008, 28: 1229-1237. 10.1007/s00296-008-0647-z.CrossRefPubMed
12.
go back to reference Kastenbauer S, Pfister HW: Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain. 2003, 126: 1015-1025. 10.1093/brain/awg113.CrossRefPubMed Kastenbauer S, Pfister HW: Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain. 2003, 126: 1015-1025. 10.1093/brain/awg113.CrossRefPubMed
13.
go back to reference Schut ES, Brouwer MC, de Gans J, Florquin S, Troost D, van de Beek D: Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis. Neurology. 2009, 73: 1988-1995. 10.1212/WNL.0b013e3181c55d2e.CrossRefPubMed Schut ES, Brouwer MC, de Gans J, Florquin S, Troost D, van de Beek D: Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis. Neurology. 2009, 73: 1988-1995. 10.1212/WNL.0b013e3181c55d2e.CrossRefPubMed
14.
go back to reference Fisher JD: Insidious presentation of pediatric pneumococcal meningitis: alive and well in the post vaccine era. Am J Emerg Med. 2009, 27: 1173-e5-7CrossRefPubMed Fisher JD: Insidious presentation of pediatric pneumococcal meningitis: alive and well in the post vaccine era. Am J Emerg Med. 2009, 27: 1173-e5-7CrossRefPubMed
15.
go back to reference Ichiyama T, Matsushige T, Kajimoto M, Tomochika K, Matsubara T, Furukawa S: Dexamethasone decreases cerebrospinal fluid soluble tumor necrosis factor receptor 1 levels in bacterial meningitis. Brain Dev. 2008, 30: 95-99. 10.1016/j.braindev.2007.06.006.CrossRefPubMed Ichiyama T, Matsushige T, Kajimoto M, Tomochika K, Matsubara T, Furukawa S: Dexamethasone decreases cerebrospinal fluid soluble tumor necrosis factor receptor 1 levels in bacterial meningitis. Brain Dev. 2008, 30: 95-99. 10.1016/j.braindev.2007.06.006.CrossRefPubMed
Metadata
Title
Unusual exanthema combined with cerebral vasculitis in pneumococcal meningitis: a case report
Authors
Theonimfi Tavladaki
Anna-Maria Spanaki
Stavroula Ilia
Elisabeth Geromarkaki
Maria Raissaki
George Briassoulis
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2011
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/1752-1947-5-410

Other articles of this Issue 1/2011

Journal of Medical Case Reports 1/2011 Go to the issue