Pyogenic ventriculitis in meningococcal meningitis: A case report

A 60 year old immunocompetent woman was diagnosed with meningococcemia and presumed meningitis after presenting with altered consciousness, headache, neck stiffness, and a purpuric rash. She had some atypical features for meningitis including nystagmus and dizziness, which persisted beyond a standard course of 7 days of intravenous ceftriaxone. Computed tomography brain and fundoscopy were normal. Magnetic resonance imaging (MRI) brain revealed pyogenic ventriculitis and ependymal enhancement. Antimicrobials were not extended due to clinical and biochemical improvement. The patient had close neurological monitoring as an inpatient and following discharge until recovery. Follow up MRI brain after 3 months was normal. Pyogenic ventriculitis is described rarely in the literature as a complication of bacterial meningitis in adults, particularly secondary to Neisseria meningitidis. Optimal antibiotic regimen and duration are not well established. It should be considered in patients not improving as per expected trajectory, including those with atypical neurology. If not recognized early, it can lead to hydrocephalus and death.