Recurrent bacterial meningitis with cerebrospinal fluid rhinorrhea

Abstract

Introduction: Recurrent bacterial meningitis is a rare clinical phenomenon, but a telltale sign of a mysterious foe. It is an occurrence of two or more episodes of bacterial meningitis by different organisms, or with the same organism and the episodes separated by an interval of at least three weeks. Case Report: We present a case of a 29-year-old gentleman who presented with acute pyogenic meningitis due to Streptococcus pneumoniae. This is the second episode of confirmed bacterial meningitis in two years with another episode of meningitis ten years ago, which was treated as tuberculous. History of rhinorrhea was elicited on direct questioning and cerebrospinal fluid leak through cribriform plate was confirmed on magnetic resonance imaging. The current episode of meningitis was successfully treated with intravenous high dose cephalosporin and short course dexamethasone. The patient was referred to a neurosurgeon for closure of cerebrospinal fluid leak. Conclusion: This case highlights the importance of a thorough clinical history and awareness of a seemingly unimportant symptom which can be an important diagnostic clue.