Pneumococcal-meningitis associated acute disseminated encephalomyelitis (ADEM) - case report of effective early immunotherapy

Cerebral Vasculitis in a Case of Meningitis

Cerebral vasculitis is a serious complication of meningitis with Streptococcus pneumoniae. We report a 5 yr old girl who was admitted in May 2015 at Fortis Hospital, Kolkata, India and was diagnosed to have pneumococcal meningitis with vasculitis on DWMRI within a week of onset of fever. She was given high dose of methyl-prednisolone simultaneously with antibiotics and successfully treated without any neuro-sequelae. Although vasculitis has been documented to develop as sequelae to bacterial meningitis usually in the second week, our patient had an early presentation. Treatment with high dose steroid along with antibiotics resulted in dramatic improvement with no neurodeficit. DW-MRI is an important investigation to pick up early, evidence of vasculitis in a patient with meningitis who is showing neurological deteriorations despite improvement in blood parameters.

Streptococcus pneumoniae Meningitis Presenting with Acute Urinary Retention and Emphysematous Cystitis

A combination of acute urinary retention and aseptic meningitis has occasionally been described, which is referred to as meningitis-retention syndrome. In contrast, acute urinary retention has rarely been reported in bacterial meningitis. We herein report a case of Streptococcus pneumoniae meningitis presenting with acute urinary retention which led to emphysematous cystitis in an elderly woman. She presented with impaired consciousness and a distended lower abdomen. She was diagnosed with pneumococcal meningitis by lumbar puncture. Abdominal computed tomography revealed the presence of emphysematous cystitis. She completely recovered with antibiotic therapy without any complications. Acute urinary retention can occur secondary to pneumococcal meningitis.