SHM Converge Scientific Abstract ePoster Gallery-Cerebral Spinal Fluid Leak Rare Cause of Bacterial Meningitis

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This case describes a previously healthy 50-year-old woman who presented with abrupt severe headache, fever, altered mental status, nausea/vomiting, sinus tenderness, and a positive Brudzinski sign, raising concern for bacterial meningitis. Her lumbar puncture showed cloudy cerebrospinal fluid with very low glucose, elevated protein, and marked pleocytosis, consistent with meningitis. Blood cultures grew <em>Streptococcus salivarius/vestibularis</em>, an unusual pathogen for community-acquired meningitis.

Initial empiric treatment included ceftriaxone, ampicillin, and vancomycin, after which her systemic symptoms improved significantly. However, she continued to have clear watery rhinorrhea that worsened when standing, coughing, or sneezing, suggesting a cerebrospinal fluid leak. Head CT and sinus imaging showed left sphenoid sinus disease and mucoperiosteal thickening, with MRI also suggesting fluid in the left sphenoid sinus as a possible leak site.

To confirm the diagnosis, beta-2 transferrin testing was performed and was positive, verifying that the nasal drainage was cerebrospinal fluid. A cisternogram was used to further evaluate the leak, though it did not clearly identify the exact location. The patient then underwent surgical repair via a transsphenoidal approach to close the sphenoid sinus CSF leak, resulting in complete resolution of symptoms.

Overall, the case highlights that spontaneous or occult CSF leaks can present as bacterial meningitis and may be missed if persistent rhinorrhea is not recognized. Prompt diagnosis, appropriate antibiotics, and definitive surgical repair of the leak are essential to prevent recurrence and reduce complications.

Asset Subtitle

Bethany J. King

Meta Tag

Author List Bethany J. King, Doh Joon Park, Duane Abbott, Garrett R. Wilt, Kindra Holsing, Maria A. Guevara Hernandez, Thomas F. Fusillo

Category Clinical Vignettes

Concept Acute Bacterial Meningitis

Concept CSF Abnormalities

Concept Spinal CSF Leak

Concept Cerebrospinal Fluid

Concept Blood Culture

Distinguished Non-Finalist

Presenter Organization MercyOne Des Moines

Presenting Author Bethany J. King

Track Adult

Keywords

bacterial meningitis

cerebrospinal fluid leak

beta-2 transferrin

Streptococcus salivarius/vestibularis

rhinorrhea

sphenoid sinus

lumbar puncture

transsphenoidal repair

CSF leak

sinusitis

Acute Bacterial Meningitis

CSF Abnormalities

Spinal CSF Leak

Cerebrospinal Fluid

Blood Culture