A Case Report of Bacterial Meningoencephalitis with Altered Sensorium in a 50-Year-Old Male

Case Report

Abstract

Bacterial meningoencephalitis remains a significant cause of morbidity and mortality worldwide, requiring prompt diagnosis and treatment. We present a case of a 50-year-old male who presented to the emergency room with a three-day history of low-grade fever, chills, altered sensorium, and recent episodes of seizures. Upon admission, the patient demonstrated positive Kernig's sign, bilateral pinpoint pupils, incomprehensible speech, and drowsiness, with a Glasgow Coma Scale score of E3M5V2. The patient had a significant history of chronic alcohol consumption spanning 32 years. Cerebrospinal fluid analysis revealed elevated protein levels (79.7 mg/dL) and the presence of Streptococcus pyogenes in culture, confirming the diagnosis of bacterial meningoencephalitis. While neuroimaging studies, including MRI and CT scan, showed no significant abnormalities, other diagnostic tests helped rule out concurrent infections. The patient received empirical antibiotic therapy with intravenous ceftriaxone, along with acyclovir, vancomycin, and supportive medications. Treatment also included management of increased intracranial pressure, seizure control, and careful monitoring of neurological status. Following a comprehensive 16-day treatment regimen, the patient showed significant improvement and was discharged in stable condition. This case shows the importance of early recognition of symptoms, prompt initiation of appropriate antimicrobial therapy, and the need for a multidisciplinary approach in managing bacterial meningoencephalitis. Regular follow-up was recommended due to the risk of relapse and potential long-term complications