Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Acute meningoencephalitis caused by streptococcus pneumoniae, mimicking acute disseminated encephalomyelitis

Juri Kureshiro, M.D., Yoshimasa Kuzumoto, M.D., Hiromi Aomatsu, M.D. and Susumu Kusunoki, M.D.

Department of Neurology, Kinki University School of Medicine

A 57-year old woman had a five-day history of cough and high fever followed by abnormal behavior and headache with signs of meningeal irritation. A cerebrospinal fluid (CSF) exam revealed polymorphonuclear pleocytosis. Streptococcus pneumoniae was cultured from the patient's CSF and serum. Clinical features and laboratory investigations supported a diagnosis of pneumococcal meningoencephalitis. After treatment with intravenous meropenem (MEPM), the patient's laboratory data improved and her neck stiffness disappeared, but a brain MRI showed white matter lesions in the bilateral frontal and temporal lobes. The patient responded to pulse therapy with intravenous methylprednisolone (1 g/day), carried out over three days: she recovered neurological function and her MRI lesions resolved.
We report a case of acute meningoencephalitis caused by Streptococcus pneumoniae, mimicking acute disseminated encephalomyelitis (ADEM). We suggest that pneumococcal infection is one of the pathogenetic factors in ADEM.
Full Text of this Article in Japanese PDF (627K)

(CLINICA NEUROL, 48: 255|258, 2008)
key words: ADEM, bacterial meningoencephalitis, pneumococcus, white matter lesions, methylprednisolone

(Received: 24-Feb-07)