Abstract
• The case reports purulent meningitis secondary to rupture of a cholesteatoma. • Direct microscopy of the lumbar cerebrospinal fluid did not reveal the etiology. • The diagnosis required prolonged cultures and subsequent MALDI-TOF MS analysis. • The patient was treated successfully with benzylpenicillin, and metronidazole. The first case of cholesteatoma associated purulent meningitis and bacteriemia due to Filifactor alocis and Porphyromonas gingivalis is reported. The patient recovered fully after acute mastoidectomy and four weeks of benzylpenicillin and metronidazole.
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