Pneumocephalus Associated with Aggressive Pneumococcal Menin
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A 44-year-old woman was admitted in the emergency department after 3 days of headache followed by hyperactive delirium. Brain tomography showed a hypodense lesion on the superior left cerebellum compatible with pneumocephalus.

A lumbar puncture was performed for extensive microbiological investigation and broad-spectrum antibiotics were initiated with vancomycin, ceftriaxone and ampicillin. Cerebrospinal fluid analysis showed 42/mm3 leucocytes with polymorphonuclear leukocytes and clear glucose consumption (1 mg/dl). The blood cultures as well as the cerebrospinal fluid culture disclosed the presence of Streptococcus pneumoniae (against which the patient had been vaccinated 3 years previously with the pneumococcal saccharide conjugate vaccine). Antimicrobial therapy was adjusted accordingly. Follow-up brain imaging (48 h later) showed resolution of the pneumocephalus. Despite receiving full intensive care treatment, the patient deteriorated and died on the third day after admission.

Learning Points:

1. Non-traumatic pneumocephalus should raise the suspicion of meningitis and prompt suitable treatment.
2. Previous pneumococcal saccharide conjugate vaccine administration does not exclude the possibility of serious pneumococcal infection.

Source: https://www.ejcrim.com/index.php/EJCRIM/article/view/1677/2081
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