Streptococcus pneumoniae Meningitis–Induced Cerebral Vasculitis: A Case Report

Streptococcus pneumoniae is a well-established etiological agent of community-acquired bacterial meningitis in adults and frequently leads to diverse neurological complications. Standard treatment involves antibiotics and a 4-day dexamethasone regimen to prevent complications. This report presents a unique case of S. pneumoniae meningitis–associated cerebral vasculitis in a middle-aged male, characterized by a trifecta: probable vasculitis, vasogenic edema and symptom relapse after a steroid taper, which was uncommon in prior case reports. Despite adhering to standard therapy, the patient exhibited a significant neurological decline. Timely detection and appropriate supportive care played pivotal roles in alleviating neurological deficits. This distinctive case highlights the exceptional rarity of S. pneumoniae meningitis–induced cerebral vasculitis, emphasizing the critical importance of early recognition, prompt diagnosis and effective management strategies. Notably, an extended steroid taper appeared beneficial in this case, suggesting the need for further studies to guide treatment duration.