Title : Recurrent pneumococcal meningitis secondary to frontal sinus encephalocele – A case report
Abstract:
Background: Recurrent meningitis is defined as having multiple episodes of meningitis caused by different or same organisms, after three weeks of completing treatment courses. Causes of recurrent meningitis can be arranged into two large categories: congenital and acquired. Each can be further subclassified into anatomical anomalies, immunodeficiencies, and chronic parameningeal infections. According to a research study, more than half of the cases reviewed in the study were attributed to anatomical distortions, followed by immunodeficiencies and then chronic parameningeal infections. Head injuries and basal skull fractures were the most common anatomical problem noted in the literature review, with cerebrospinal fluid fistulas secondary to head injury as the most common subtype. Encephaloceles were reported to be congenital and rarely acquired secondary to surgeries or traumas. Streptococcus pneumoniae was, by far, the most commonly isolated organism from the head injuries category. This type of meningitis requires prompt investigations for underlying structural or immunological defects.
Case Report: We report a case of a 22-year-old man with his second attack of pneumococcal meningitis within a one-year timeframe after sustaining a road traffic accident about 4 years ago. The patient sustained left frontal bone fracture communicating with the left frontal sinus, along with left frontal encephalocele.
Conclusions: The study aims to highlight that an underlying cause should be investigated with recurrent meningitis, especially in previously healthy individuals with no comorbidities. This should be done using a systematic approach. Physicians need to keep a high suspicion index with regards to structural defects, especially in patients who do not have any obvious risk factors, even if immunological or infectious etiologies contribute for the majority of cases. Multidisciplinary team approach and high-resolution imaging are essential for precise diagnosis and efficient treatment.
