Community-acquired pneumococcal meningoencephalitis associated with neurosyphilis in an immunocompetent patient: case report
Authors: Beretta Luiza de Lima , Nascimento Arthur Costa , Santos Diogo Fernandes dos 
Published: July 2023

Case report: A 28-year-old man with no comorbidities was admitted to our institution with a history of sudden holocranial headache, associated with fever, lowered level of consciousness and meningismus with the need for orotracheal intubation. Computed tomography of the brain was normal and the cerebrospinal fluid (CSF) on 05/28/2022 was yellowish, cloudy, glucose 6.0 mg/ dL, protein 752 mg/dL, cells 25,600 mm³ (neutrophils 92%, lymphocytes 5%), red blood cells 258 mm³, CSF Venereal Disease Research Laboratory (VDRL) 1/8, serum VDRL 1/32, treponemal test positive, human immunodeficiency virus (HIV) negative. Ceftriaxone, ampicillin, and acyclovir were empirically started. Pneumococcus was identified in the culture of CSF and blood cultures on admission and the antibiotic regimen was adequate, maintaining only ceftriaxone. Antibiotic therapy lasted 14 days, he was discharged after 16 days of hospitalization, for outpatient follow-up, with no neurological deficits. Control lumbar puncture on 12/23 revealed clear, colorless CSF, glucose 56 mg/dL, total protein 31.8 mg/dL, no cells or red blood cells, cultures negative. Discussion: Streptococcus pneumoniae is the most common cause of meningitis in adults, in older adults and in the current era, neurosyphilis, is most frequently seen in persons with HIV. There are no similar cases described in the literature. Despite the effectiveness of current antibiotics in clearing bacteria from the CSF, bacterial meningitis continues to cause significant morbidity and mortality worldwide. We describe a rare case of an immunocompetent patient with communityacquired pneumococcal meningoencephalitis associated with neurosyphilis treated with ceftriaxone who did not present sequelae or need for retreatment. Conclusion: It´s a rare cause of meningoencephalitis and has significant morbidity and mortality. More studies are needed regarding susceptibility to meningoencephalitis by multiple germs in immunocompetent patients.Case report: A 28-year-old man with no comorbidities was admitted to our institution with a history of sudden holocranial headache, associated with fever, lowered level of consciousness and meningismus with the need for orotracheal intubation. Computed tomography of the brain was normal and the cerebrospinal fluid (CSF) on 05/28/2022 was yellowish, cloudy, glucose 6.0 mg/ dL, protein 752 mg/dL, cells 25,600 mm³ (neutrophils 92%, lymphocytes 5%), red blood cells 258 mm³, CSF Venereal Disease Research Laboratory (VDRL) 1/8, serum VDRL 1/32, treponemal test positive, human immunodeficiency virus (HIV) negative. Ceftriaxone, ampicillin, and acyclovir were empirically started. Pneumococcus was identified in the culture of CSF and blood cultures on admission and the antibiotic regimen was adequate, maintaining only ceftriaxone. Antibiotic therapy lasted 14 days, he was discharged after 16 days of hospitalization, for outpatient follow-up, with no neurological deficits. Control lumbar puncture on 12/23 revealed clear, colorless CSF, glucose 56 mg/dL, total protein 31.8 mg/dL, no cells or red blood cells, cultures negative. Discussion: Streptococcus pneumoniae is the most common cause of meningitis in adults, in older adults and in the current era, neurosyphilis, is most frequently seen in persons with HIV. There are no similar cases described in the literature. Despite the effectiveness of current antibiotics in clearing bacteria from the CSF, bacterial meningitis continues to cause significant morbidity and mortality worldwide. We describe a rare case of an immunocompetent patient with communityacquired pneumococcal meningoencephalitis associated with neurosyphilis treated with ceftriaxone who did not present sequelae or need for retreatment. Conclusion: It´s a rare cause of meningoencephalitis and has significant morbidity and mortality. More studies are needed regarding susceptibility to meningoencephalitis by multiple germs in immunocompetent patients.