Beta-hemolytic group B Streptococcus meningitis in a young healthy woman

Abstract

Introduction: Group B Streptococcus (GBS) is the leading cause of bacterial meningitis and sepsis in neonates but is a rare cause of meningitis in adults. The GBS infections in adults include bloodstream infections, pneumonia, skin and soft-tissue infections, and bone and joint infections. Case Report: A 23-year-old woman with a past medical history of stroke at the age of four and Staphylococcus aureus toxic shock syndrome at age 10 was presented to the emergency department with three days of worsening frontal headache, fatigue and mild confusion. Patient denied fever, photophobia, neck stiffness, nausea and vomiting. Brudzinski’s sign and Kernig’s sign were negative. Laboratory data showed initially elevated WBC (13.5x103/ μL) and normal metabolic panel. Cerebrospinal fluid (CSF) analysis was normal with two white cells, all lymphocytes. After two days of hospitalization, she was back to her normal state without any headache or confusion and was discharged home. One day after discharge, both urine and CSF culture grew β-hemolytic GBS but with negative blood cultures. She was readmitted and placed on ceftriaxone 2g IV twice daily for 14 days. Conclusion: This case illustrates an unusual presentation of group B Streptococcus meningitis. Internists should be aware of atypical group B Streptococcus meningitis and consider treating patients with empiric antibiotics on clinical suspicion.