Persisting vasculitis after pneumococcal meningitis.

Abstract:

INTRODUCTION:Bacterial meningitis is associated with a high mortality and a high incidence of neurological sequelae. Parainfectious vasculitis leading to ischemic brain damage is a known complication of bacterial meningitis but its treatment is uncertain. METHODS AND RESULTS:We report the case of a 53-year-old man with pneumococcal meningitis who developed numerous ischemic lesions in the brainstem and basal ganglia caused by parainfectious vasculitis. Clinical and radiological improvement was observed after delayed corticosteroid initiation. Symptomatic vasculitis relapsed after steroid withdrawal and stabilized after reintroduction of the immunosuppressive therapy. Although the cerebrospinal fluid (CSF) contained high levels of MMP-9 at the time of symptomatic vasculitis, a significant decrease of the enzyme accompanied the introduction of corticotherapy and the regression of vasculitic symptoms. No relation between the level of MMP-9 and the white blood cell count in CSF could be found. CONCLUSION:Parainfectious vasculitis may respond to late corticosteroid treatment. MMP-9 level in CSF may be a marker of vasculitic complication in bacterial meningitis.

journal_name

Neurocrit Care

journal_title

Neurocritical care

authors

Pugin D,Copin JC,Goodyear MC,Landis T,Gasche Y

doi

10.1385/NCC:4:3:237

subject

Has Abstract

pub_date

2006-01-01 00:00:00

pages

237-40

issue

3

eissn

1541-6933

issn

1556-0961

pii

NCC:4:3:237

journal_volume

4

pub_type

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