Clival defect in the pathogenesis of recurrent meningitis: a case report and literature review

Ahmet Naci Emecen,Reyhan Ertekin,Haluk Vahaboglu,Begumhan Baysal,Ferhat Arslan

doi:10.1186/s41984-019-0066-3

Ahmet Naci Emecen, Reyhan Ertekin + Show 3 more

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https://doi.org/10.1186/s41984-019-0066-3

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Abstract

BackgroundMeningitis is a life-threatening infection often associated with high morbidity. Recurrent bacterial meningitis poses a clinical challenge, both clinically and diagnostically. To prevent further recurrences, the underlying causes of recurrent bacterial meningitis should be investigated intensively.Case presentationHere, we aim to present a patient referred to our clinic with rhinorrhea and found to the Staphylococcus aureus meningitis related to a clival defect. The patient reported no history of trauma, surgery, or brain neoplasm, and the cerebrospinal fluid leakage was classified as spontaneous. The patient had two episodes of meningitis in the last 4 years, but etiologic data of the previous episodes were absent. A pneumococcal vaccine was administered following her second attack, suggesting a possible Staphylococcus aureus infection due to altered colonization in the sinuses. She was successfully treated with linezolid but refused surgery to correct the defect and was discharged without neurologic sequelae.ConclusionSpontaneous cerebrospinal fluid leakage from the clivus which could provoke recurrent meningitis is a rare situation. In conjunction with appropriate rapid antibiotherapy for the prevention of recurrent meningitis, the removal of anatomical risk factors should be a principal aim. Effective surgical procedures prevent recurrences.

Highlights

Meningitis is a life-threatening infection often associated with high morbidity
The clivus is found in the deepest region of the skull base with one of its walls adjacent to the top of the sphenoid sinus
Cerebrospinal fluid (CSF) leakage from the clivus could lead to recurrent meningitis

Summary

Introduction

Meningitis is a life-threatening infection often associated with high morbidity. Recurrent bacterial meningitis poses a clinical challenge, both clinically and diagnostically. A pneumococcal vaccine was administered following her second attack, suggesting a possible Staphylococcus aureus infection due to altered colonization in the sinuses She was successfully treated with linezolid but refused surgery to correct the defect and was discharged without neurologic sequelae. Medical history revealed two meningitis episodes: the first being 4 years and the second 2 years previously Medical data concerning these episodes were absent, but she had been successfully treated with intravenous antibiotics. She was vaccinated with 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) following the second meningitis attack. She declared no head trauma, surgery, malignancy, or sinus and ear infections. Her white blood cell (WBC) count was 12,300/mm and C-reactive protein level was 1.3 mg/dl

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