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.
Highlights
Group B Streptococcus (GBS) is the leading cause of bacterial meningitis and sepsis in neonates but is a rare cause of meningitis in adults
Internists should be aware of atypical group B Streptococcus meningitis and consider treating patients with empiric antibiotics on clinical suspicion
We report a very unique case of group B Streptococcus meningitis in a 23-year-old non-pregnant immunocompetent female
Summary
Group B Streptococcus (GBS) is gram-positive β-hemolytic coccus characterized by the presence of group B Lancefield antigen and the main virulence factor is the polysaccharide anti-phagocytic capsule. Www.ijcasereportsandimages.com toxic shock syndrome at age 10 was presented to the emergency department with three days of worsening frontal headache, fatigue and mild confusion. She complained of continuous throbbing-like headache in the left frontal lobe, which she rated as 8 on a severity scale of 10. Both urine and CSF culture grew β-hemolytic GBS. CSF culture showed 4 colonies of β-hemolytic GBS and urine culture showed 50,000 organisms/mL She was readmitted and placed on ceftriaxone 2 g IV twice daily for 14 days. Our case was unique such that the patient denied fever and presented with headache, confusion and normal CSF analysis
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