Unusual manifestation in a case of nocardial meningitis.

A case of subacute progressive painful external ophthalmoplegia of the right eye in a 55-year-old woman is reported. CT scan of the brain, paranasal sinuses and orbits revealed normal findings. Tolosa-Hunt syndrome was diagnosed and high dose prednisolone was given. The patient later developed fever, confusion and stiffneck. Lumbar puncture showed grossly purulent CSF with Gram-positive coccobacilli and rod organism. CSF culture grew Nocardia spp. The patient made a complete recovery with trimethoprim-sulfamethoxazole treatment.

Group A beta-hemolytic streptococcal meningitis in adults.

Two cases of Group A beta-hemolytic streptococcal meningitis are reported. One patient presented with fever, coma, seizure and was associated with skull defect whilst the other had meningitis after surgical removal of an epidural cyst. The first died but the latter completely recovered. This organism should be considered in patients with skin wounds and bacterial meningitis due to Gram-positive cocci.