Abstract
A seventy-one-year-old male was transferred to the emergency room of our hospital with the diagnosis of suspected meningitis by a previous physician owing manifestations of sudden-onset high-grade fever, unconsciousness, and nuchal rigidity. On spinal tap examination, microscopy observation showed numerous bacteria and no pleocytosis, and a chemical examination revealed a low glucose level and high levels of protein, lactate dehydrogenase (LD), and creatine kinase (CK). LD isozyme analysis detected LD1, LD2, and LD3, which come from brain cells, but not LD4 or LD5. CK isozyme analysis showed an increase in the level of CK-BB, indicating brain cell damage or brain tissue injury. Unfortunately, he died on the same day. Streptococcus agalactiae cells were cultured from his blood and spinal fluid samples. Thus, he was suspected as having had bacterial meningitis. This patient was considered immunocompromised because of other underlying diseases or physiology such as being elderly and having diabetes mellitus and chronic renal failure. Because of his poor immune response, the patient showed no pleocytosis, and severe bacterial infection and brain cell damage developed rapidly.
