ABSTRACT
Austrian syndrome is a triad characterized by pneumonia, meningitis and endocarditis, as a result of a Streptococcus pneumoniae bacteremia. We report a previously healthy 49 year-old male, who consulted at the emergency care unit with a history of one week of pleuritic pain, fever leading to an altered level of consciousness and seizures. A diagnosis of community-acquired pneumonia and meningitis was reached, isolating Streptococcus pneumoniae in the cerebrospinal fluid and blood cultures. Antibiotic treatment was started but the patient had an unsatisfactory response. During hospitalization a new heart murmur was found in the physical examination. An echocardiography was performed and a massive aortic valve insufficiency was found along with vegetations and a perforation of the same valve. The valve was replaced by a prosthetic one and the patient responded satisfactorily to the surgical and antibiotic treatment, without complications.
Subject(s)
Humans , Male , Middle Aged , Pneumonia, Pneumococcal/microbiology , Streptococcus pneumoniae/isolation & purification , Meningitis, Bacterial/microbiology , Endocarditis, Bacterial/microbiology , Pneumonia, Pneumococcal/surgery , Pneumonia, Pneumococcal/diagnostic imaging , Syndrome , Tomography, X-Ray Computed , Meningitis, Bacterial/surgery , Meningitis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/diagnostic imagingABSTRACT
A previously healthy 16-month-old Korean girl with symptoms of fever, vomiting, and generalized tonic seizure was diagnosed to have Group D non-typhoid Salmonella meningitis. The patient was treated with ceftriaxone (100 mg/kg/day) and amikin (22.5 mg/kg/day) initially and ciprofloxacin (30 mg/kg/day) was added later because of clinical deterioration and disseminated intravascular coagulation. Brain CT performed on the second day showed a well-demarcated low density lesion in the right lentiform nucleus and both caudate nuclei, without evidence of increased intracranial pressure. MRI performed on the 11th day confirmed CT scan findings as well as right subdural fluid collection, brain atrophy, and ventriculomegaly. She underwent subdural drainage and later ventriculo-peritoneal shunt operation. Despite receiving intensive treatment, she still has severe neurologic sequelae. Our case shows that infarctions of basal ganglia and thalami are not specific for tuberculous meningitis and that meningitis complicated by infarction is indicative of grave prognosis.
Subject(s)
Female , Humans , Infant , Basal Ganglia Diseases/diagnostic imaging , Basal Ganglia Diseases/pathology , Basal Ganglia Diseases/complications , Basal Ganglia Diseases/cerebrospinal fluid , Brain/diagnostic imaging , Brain/pathology , Cerebral Infarction/diagnostic imaging , Cerebral Infarction/pathology , Cerebral Infarction/complications , Cerebral Infarction/cerebrospinal fluid , Follow-Up Studies , Magnetic Resonance Imaging , Meningitis, Bacterial/diagnostic imaging , Meningitis, Bacterial/pathology , Meningitis, Bacterial/complications , Meningitis, Bacterial/cerebrospinal fluid , Salmonella Infections/complications , Tomography, X-Ray Computed/methodsABSTRACT
Forty infants with proven pyogenic meningitis were evaluated by real time cranial sonography. A spectrum of sonographic abnormalities was observed which included echogenic sulci, focal or diffuse increase in parenchymal echoes, ventriculitis, ventriculomegaly with or without aqueductal block, subdural collection, parenchymal infarcts, abscess and subdural empyema. There were two infants with normal sonogram while encephalomalacia was seen in another two patients. An excellent correlation was observed between clinical profile, cerebrospinal fluid biochemistry and sonographic findings.