Penicillin-Resistant Streptococcus Pneumoniae Meningitis With Subsequent Vertebral Osteomyelitis and Choledocholithiasis

Abstract

Penicillin-resistant Streptococcus pneumoniae (PRSP) meningitis is life threatening disease, and prevention and treatment of complication is important. We recently encountered two PRSP meningitis patients with undescribed complications: vertebral osteomyelitis and choledocholithiasis. Patient 1 was a 65-year-old man who presented with PRSP meningitis, disseminated intravascular coagulation (DIC), infective endocarditis, vertebral osteomyelitis, and choledocholithiasis with gallstones. Patient 2 was a 57-year-old man who presented with PRSP meningitis, DIC, acute renal failure, liver dysfunction, vertebral osteomyelitis, and choledocholithiasis with gallstones. Diffusion-weighted brain MRI of both patients revealed high-intensity areas in the posterior horns of the lateral ventricles consistent with ventriculitis. Spinal MRI revealed low-intensity on T1-weighted images and high-intensity on T2-weighted images of the lumbar vertebral bodies and intervertebral disks, consistent with vertebral osteomyelitis. Technetium-99m bone scans revealed accumulation in the lumbar vertebrae. Computed tomography (CT) scans on admission revealed no gallstones, whereas CT scans after abdominal pain or liver dysfunction revealed choledocholithiasis and gallstones. Vertebral osteomyelitis and choledocholithiasis should be noted as possible complications of PRSP meningitis. J Med Cases. 2014;5(2):108-112 doi: http://dx.doi.org/10.14740/jmc1598e