Fulminant Community-Acquired Meningitis Caused by Streptococcus Pneumoniae

Short Communication

A 62-years-old woman presented to Emergency Department for fever, vomiting, dyspnea, lethargy. Physical examination revealed cyanosis and cutaneous purpura.

A blood count showed a severe pancytopenia (Hemoglobin, 3,7 g/dl; Leukocytes, 0,8 x 10⁹/L; Platelets, 28 x 10⁹/L). Peripheral blood smear demonstrated a large number of Diplococci; same distorted granulocytes, containing toxic vacuoles and intracellular structure, were suggestive for phagocytized cocci. Biochemistry revealed drastic hypoglycemia (< 4 mg/dl) and acute renal failure (serum creatinine 9,1 mg/dl, creatinine-clearance 4 ml/min/1,73 m²). Procalcitonin was very high, 187 ng/ml (n.v. < 0,5), as serum creatine-phosphokinase level, 1224 mU/ml (n. v. 34-145). Chest radiography was normal. She had no history of previous onco-hematological or immunosuppressive disease. Blood cultures confirmed a disseminated infection caused by Streptococcus Pneumoniae, with a dramatic meningitis associated to ”purpura fulminans” and acute renal failure with rhabdomyolysis. Although intensive treatments, the patient died less than 3 hours after (Figure 1).

    

    

    Figure 1: Diplococci and distorted granulocytes, with toxic vacuoles and sign of phagocytosis.