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Peer-reviewedCC BY 4.0Cureus

Recurrent Pneumococcal Meningitis Without Cerebrospinal Fluid Pleocytosis and With Fulminant Septic Shock: A Case Report

  • Daisuke Shiina1,2
  • Koichi Zokumasu1
  1. 1Emergency Medicine, Kanto Central Hospital, Tokyo, JPN
  2. 2Gastroenterology, National Center for Global Health and Medicine, Tokyo, JPN
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Abstract

Bacterial meningitis is typically diagnosed via lumbar puncture. It usually occurs with cerebrospinal fluid (CSF) abnormalities. This report describes the case of a 68-year-old man with recurrent pneumococcal meningitis and absence of significant CSF pleocytosis. Despite a thorough search, no infectious focus was identified. The patient lacked typical meningeal signs, such as neck stiffness, and did not initially present with marked alteration of consciousness. Prompt antibiotic therapy was initiated; however, the patient died on the day of admission. On the day after his death, Gram-positive diplococci were detected in blood, urine, and CSF cultures and were subsequently identified as Streptococcus pneumoniae. The CSF examination showed no findings strongly suggestive of meningitis.

Atypical presentations of meningitis may lead to delays in diagnosis and treatment. To the best of our knowledge, reports of such cases are rare.

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Cite

BibTeXRIS
BibTeX
@article{shiina2026recurrent,
  title = {{Recurrent Pneumococcal Meningitis Without Cerebrospinal Fluid Pleocytosis and With Fulminant Septic Shock: A Case Report}},
  author = {Daisuke Shiina and Koichi Zokumasu},
  journal = {Cureus},
  year = {2026},
  month = sep,
  doi = {10.7759/cureus.116945},
  url = {https://doi.org/10.7759/cureus.116945},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Recurrent Pneumococcal Meningitis Without Cerebrospinal Fluid Pleocytosis and With Fulminant Septic Shock: A Case Report
AU  - Daisuke Shiina
AU  - Koichi Zokumasu
PY  - 2026
DA  - 2026/09/25
JO  - Cureus
DO  - 10.7759/cureus.116945
UR  - https://doi.org/10.7759/cureus.116945
AB  - Bacterial meningitis is typically diagnosed via lumbar puncture. It usually occurs with cerebrospinal fluid (CSF) abnormalities. This report describes the case of a 68-year-old man with recurrent pneumococcal meningitis and absence of significant CSF pleocytosis. Despite a thorough search, no infectious focus was identified. The patient lacked typical meningeal signs, such as neck stiffness, and did not initially present with marked alteration of consciousness. Prompt antibiotic therapy was initiated; however, the patient died on the day of admission. On the day after his death, Gram-positive diplococci were detected in blood, urine, and CSF cultures and were subsequently identified as Streptococcus pneumoniae. The CSF examination showed no findings strongly suggestive of meningitis.  Atypical presentations of meningitis may lead to delays in diagnosis and treatment. To the best of our knowledge, reports of such cases are rare.
SN  - 2168-8184
ER  -