Atypical Streptococcal Meningitis with Fatal Cerebrovascular Complications: A Case Report

Lemierre Syndrome Associated with Streptococcus constellatus and Atypical Vascular Involvement: A Case Report and Review of the Literature

Background: Lemierre syndrome is a rare and life-threatening disease. It is characterized by septic thrombophlebitis of the internal jugular vein, historically associated with Fusobacterium necrophorum infection. However, atypical cases and associations with other organisms have been reported. Methods: Here, we describe a challenging case of Lemierre syndrome in a 71-year-old woman caused by Streptococcus constellatus and review the related literature. Case: The patient experienced multiple hospital admissions due to misdiagnoses and developed thrombosis involving the internal jugular vein and transverse sinus bilaterally, pulmonary complications including the formation of a pseudoaneurysm, and occipital abscess. She presented with headaches, neck pain, and blindness. Prolonged antibiotic therapy was administered, leading to gradual improvement of symptoms, with partial resolution of blindness. Prophylaxis with intramuscular penicillin was prescribed at discharge. Conclusions: Our case underscores the importance of considering Lemierre syndrome in patients who present with multiple thrombotic events affecting the intracranial circulation and/or jugular veins, particularly in those already receiving anticoagulation therapy or with no identifiable cause for thrombosis, even in the absence of sore throat or fever.

Current Patient Management for Bacterial Meningitis Simultaneously Affected by Stroke

Bacterial meningitis (BM) is a critical central nervous system infection characterized by increased risks of complications and potentially fatal outcomes. The chances of full recovery are significantly reduced in the presence of concomitant neurovascular complications such as ischemic and hemorrhagic strokes, intracerebral hemorrhage, and cerebral sinus thrombosis. Effective treatment of BM requires a targeted approach that simultaneously addresses the causative pathogen and manages the neurologically related complications. However, clinicians continue to face challenges in determining optimal pharmacotherapy for these patients. The presence of neurological complications is pivotal in determining patient outcomes, contributing to high disability and mortality rates. Early medical management is crucial and begins with essential stabilization followed by rapid diagnostic testing and the administration of empirical broad-spectrum antimicrobial therapy. The use of targeted antibiotics based on culture results is standard, with adjunct therapies such as dexamethasone and, in some cases, anticoagulants playing supportive roles. Despite the deployment of such comprehensive therapeutic strategies, the variability in treatment response and the high incidence of adverse outcomes necessitate ongoing research. This includes exploring novel therapeutic approaches and enhancing current clinical practices through retrospective studies and clinical trials to mitigate the high morbidity and mortality rates associated with BM and its complications. Strategic management is crucial for patient recovery, considering the substantial risk, a broad spectrum of complications, and fatal outcomes from this meningeal infection and stroke. The use of antimicrobial therapy with intravenous adjunct dexamethasone is the current standard of care for patients with cerebrovascular complications and acute BM. In addition, other options that can provide benefits in complicated cases include anticoagulants and neurosurgery. Further investigation into treatment algorithms for patients with meningeal infection complicated by stroke and/or increased intracranial pressure is still needed.

Investigating the Role of Invasive Streptococcus Constellatus Infection in Severe Systemic Disease Manifestations: A Case Report

We hope to add to the literature evidence regarding the increasing morbidity associated with an invasive infection by a normal body commensal, Streptococcus constellatus (S. constellatus). An increasing amount of literature documentation of intra- and extracranial disease manifestations following a systemic infection by this micro-organism is noted. We describe the findings of severe, necrotizing right lung disease and possible septic brain emboli in a 54-year-old gentleman in whom microbiological investigations suggest Streptococcal pneumonia, S. constellatus, and mixed anaerobes as possible culprit micro-organisms causing his severe disease state.

Successful Interventional Treatment of Pyopneumothorax Caused by Streptococcus constellatus Associated with Hashimoto's Thyroiditis: A Case Report and Literature Review

Background

Streptococcus constellatus rarely causes pyopneumothorax, which is a serious state and requires a surgery. However, not every patient can tolerate surgery and individualized solutions are needed. Furthermore, many known situations are risk factors of S. constellatus infection, but S. constellatus pyopneumothorax associated with Hashimoto's thyroiditis has not been reported.

Case Presentation

We present the case of a 74-year-old male with multiple encapsulated pyopneumothorax caused by S. constellatus. Given his respiratory failure, we provided two-stage percutaneous right empyema radiography for catheter drainage in the radiology interventional department instead of surgery. Moreover, an occult Hashimoto's thyroiditis was discovered in the patient, which was possibly associated with S. constellatus pyopneumothorax. Levothyroxine was administered to improve his situation.

Conclusion

To our knowledge, it is the first case described in this context. We provided an alternative treatment for S. constellatus encapsulated pyopneumothorax in patient who might not tolerate surgery. We also revealed the possible relationship between S. constellatus pyopneumothorax and Hashimoto's thyroiditis.

Bacterial Meningitis With Cerebral Edema in a Young Adult: A Simulation Case for Medical Students

Introduction

Simulation in the preclinical medical education setting is a beneficial tool for students to develop clinical skills, supplement preexisting knowledge, and prepare for clinical rotations and beyond. We detail the complete simulation scenario, including a participant postresponse questionnaire, of a 28-year-old male who developed bacterial meningitis after experiencing an upper respiratory infection in the days prior.

Methods

Simulation fellows and faculty at the Alabama College of Osteopathic Medicine created a simulation scenario pertaining to bacterial meningitis. The scenario utilized a high-fidelity patient simulator, one standardized participant for patient voiceover, one standardized participant as a patient family member, and one standardized participant as a physician consultant on an as-needed basis. Sixteen preclinical medical students from various specialty interest groups were recruited to participate in the scenario and complete the postscenario questionnaire.

Results

The simulation scenario was well received by the participants, and 15 of 16 completed the postscenario questionnaire. Ninety-three percent strongly agreed the simulation was a valuable clinical experience. Additionally, 73% of participants strongly agreed that the simulation experience was realistic, 80% strongly agreed that it tested their clinical reasoning ability, and 53% strongly agreed it was appropriate for their level of clinical knowledge.

Discussion

Medical simulation is a valuable educational tool tailored to maximize student learning and supplement the traditional didactic curriculum. The successful development and implementation of our meningitis simulation case further supports the continued use of medical simulation in the preclinical setting.