Spontaneous Enterococcus faecalis Meningitis in an Elderly Patient: A Rare Cause of Community-Acquired Bacterial Meningitis

Enterococcus faecalis (E.faecalis) is an uncommon cause of bacterial meningitis in adults, typically associated with neurosurgical procedures, central nervous system devices, or underlying comorbidities.Communityacquired meningitis caused by this microorganism is particularly rare.We report the case of a 76-year-old man who presented to the emergency department with acute prostration and altered mental status, without classical meningeal signs.Initial cranial CT revealed no acute abnormalities.Cerebrospinal fluid (CSF) analysis showed findings strongly suggestive of bacterial meningitis, and E. faecalis was subsequently identified as the causative pathogen.Intravenous ampicillin and ceftriaxone were administered, with progressive neurological improvement.An extensive diagnostic workup, including cranial MRI, transthoracic echocardiography, thoracoabdominal CT, and colonoscopy, failed to identify a definitive source of infection.This case report highlights the diagnostic challenges of E. faecalis meningitis in older adults, particularly in the absence of classical meningeal manifestations and an identifiable infectious source.It also underscores the importance of early recognition, comprehensive microbiological investigation, and appropriate antimicrobial therapy in the management of this rare clinical entity.