A 95-year-old male with pneumococcal meningitis and cervical epidural abscess

Abstract

　Our patient was a 95-year-old male with a chief complaint of neck pain. Neurological findings included impaired consciousness Japan Coma Scale (JCS) score of 100 and neck stiffness. Gram staining of the cerebrospinal fluid revealed numerous pneumococci, leading to a diagnosis of pneumococcal meningitis. Cervical magnetic resonance imaging revealed findings suggestive of an epidural abscess in the C3‐C7 region. Combination therapy with dexamethasone and meropenem was initiated upon admission, which improved the patient’s clinical condition.
　The time from symptom onset to treatment initiation has been strongly associated with mortality or neurological sequelae. In particular, cases such as the current one, wherein pneumococcal meningitis, fever, and neck pain were all present, require prompt testing while considering the possibility of CEA. We herein report our experience with a rare case involving a severe infectious disease in an elderly patient with pneumococcal meningitis complicated by widespread CEA, in whom early diagnosis and treatment were life-saving, along with a review of relevant literature.