Abstract

Meningitis due to Streptococcus pyogenes is rare. It usually takes place in patients with underlying disorders and sometimes in healthy subjects without any risk factors. We present a case with fatal acute bacterial meningitis caused by S. pyogenes in an elderly patient. The patient was an eighty-nine year old female who was admitted to hospital with high fever and unconsciousness. In physical examination, she had neck stiffness, and Kerning and Brudzinski signs were negative. In the blood tests, leukocytosis was 19 300/mm3 with a predominance of 85% polymorphonuclear leukocytes (PNLs). Cranial computed tomography was relevant with infection in lateral part of the pons. In cerebrospinal fluid (CSF) examination, pressure was high, it was purulent and Pandy reaction was (++++) positive. We detected 710 leukocytes/mm3 and Gram-positive cocci in microscopic examination. The case was diagnosed as bacterial meningitis and cefotaxime 4×2 g and ampicillin 4×3 g were started empirically. S. pyogenes was isolated in blood and CSF cultures. The patient was unresponsive to treatment and passed away. S. pyogenes is a pathogen which should be kept in mind in diagnosis of cases with acute purulent meningitis.