Purulent Streptococcus Pneumoniae meningitis with suppurative focus and infectious vasculitis leading to ischemic and hemorrhagic strokes: A rare case report

Acute bacterial meningitis (ABM) is a neurological emergency that continues to cause high levels of morbidity and mortality worldwide. Despite advances in antimicrobial therapy and vaccination, it continues to cause severe neurological sequelae. In both adults and children older than 2 years, <i>Streptococcus pneumoniae</i> is the leading cause of acute bacterial meningitis, often leading to life-threatening complications. Vascular complications are seen in 15%-20% of all cases of acute bacterial meningitis, and intracerebral hemorrhages occur in 2% of patients. Coexistence of ischemic and hemorrhagic complications is rare. The authors report an infrequent case of pneumococcal meningitis in a comatose patient transferred to the emergency department by civil protection. Radiological work-up with computed tomography (CT) and magnetic resonance imaging (MRI), followed by cerebrospinal fluid (CSF) analysis, enabled accurate identification of the underlying etiology and allowed timely, targeted therapeutic management.