Patients with liver cirrhosis are at increased risk of contracting bacterial infections [1]. The association of liver cirrhosis with adult bacterial meningitis is well known [1, 2], even though it was not mentioned in one large review of bacterial meningitis in adults [3]. In a report from Taiwan in 1999, liver cirrhosis was a predisposing factor in 3.6% of cases of bacterial meningitis in adults [4]. Although Klebsiella pneumoniae is not a common pathogen in cases of adult bacterial meningitis in Western countries [3], it is an important causative pathogen in Taiwan, especially among adults with community-acquired bacterial meningitis [4]. Nevertheless, the clinical characteristics of acute bacterial meningitis in adult patients with liver cirrhosis have rarely been documented in the literature [5]. Therefore, we analyzed the clinical manifestations, laboratory findings, and therapeutic outcomes of eight adult patients with liver cirrhosis suffering from community-acquired spontaneous bacterial meningitis (CASBM) due to Klebsiella pneumoniae infection. During a period of 15 years (January 1986–December 2000), 122 cases of CASBM in adults were identified at the Chang Gung Memorial Hospital-Kaohsiung, Taiwan. Among these 122 patients were nine with liver cirrhosis. The causative pathogen in these nine patients with CASBM was Klebsiella pneumoniae in eight and Streptococcus oralis in one. Among the 113 patients without liver cirrhosis, Klebsiella pneumoniae infection was found in 43. Liver cirrhosis was defined according to the cirrhotic features identified on abdominal ultrasound and abnormal results of liver biochemical tests [6]. The diagnosis of acute bacterial meningitis was based upon the following criteria: (i) the isolation of bacterial pathogens from one or more cerebrospinal fluid (CSF) cultures; (ii) clinical manifestations of meningitis, including fever, disturbed consciousness, and signs of meningeal irritation; and (iii) CSF findings indicative of purulent inflammation, including a decreased glucose level or a decreased glucose ratio (CSF glucose/serum glucose), increased lactate and protein concentrations, and pleocytosis. The characteristics of the eight patients with liver cirrhosis and CASBM due to Klebsiella pneumoniae are listed in Table 1. Liver cirrhosis was related to alcohol in three patients, hepatitis B in two, hepatitis C in one and undetermined causes in two. Liver cirrhosis was the sole underlying condition in three of the patients, and concomitant diabetes mellitus (DM) was found in five. Mild nephropathy was found in two of the patients with DM. The clinical manifestations of infection in these 8 patients included altered consciousness (Glasgow coma scale, 10 109/l) was found in four. All eight patients had thrombocytopenia (platelet count, <140 109/l). The CSF data of all eight patients are listed in Table 1. Despite appropriate antibiotic therapy, five patients died. Among the deceased, liver cirrhosis was related to hepatitis B infection in two patients, hepatitis C infection in one, alcohol in one and an undetermined cause in one. Of the four surviving patients, two experienced a full recovery while one recovered with hearing loss. In this study, Klebsiella pneumoniae was implicated as the causative pathogen in 38% (43/113) and 89% (8/9) of cases of CASBM for adult patients without and with liver W. N. Chang · C. H. Lu · C. R. Huang ()) Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung, Taiwan e-mail: cwenneng@ms19.hinet.net Tel.: +886-7-7317123 ext. 2283 Fax: +886-7-7333816