Adynamic ileus as an atypical manifestation of <i>Staphylococcus aureus</i> meningitis confirmed by metagenomic next-generation sequencing: A case report

<i>Staphylococcus aureus</i> is an uncommon cause of bacterial meningitis, and <i>S. aureus</i> meningitis complicated with adynamic ileus has not been previously documented. This report presents a rare case of a man in his late 30s who developed purulent meningitis and intestinal pseudo-obstruction secondary to a skin-derived <i>S. aureus</i> infection. The patient initially presented with persistent fever, headache, and altered mental status. Subsequently, he developed abdominal distention, vomiting, dysuria, and meningeal signs. Laboratory tests revealed hyponatremia and elevated cerebrospinal fluid pressure; however, conventional cerebrospinal fluid culture failed to detect any pathogen. Diagnosis was ultimately confirmed through metagenomic next-generation sequencing, which identified <i>S. aureus</i> as the causative agent. Targeted antimicrobial therapy with vancomycin and meropenem resulted in rapid clinical improvement. This case highlights the importance of considering central nervous system infections in patients presenting with unexplained gastrointestinal and autonomic symptoms. Moreover, it emphasizes the clinical utility of metagenomic next-generation sequencing in identifying pathogens in culture-negative, atypical infections. Early recognition and intervention are essential to improving outcomes in such complex presentations.