Atypical Acinetobacter baumannii Meningitis: Case Report

Abstract

A patient with an unusual clinical form of acinetobacter meningitis is presented. A 42-year-old female patient who was a victim of domestic violence 1.5 months before was admitted to the emergency department with the complaints of fever, nausea, vomiting, and confusion. The cerebrospinal fluid (CSF) obtained from lumbar puncture (LP), showed normal pressure and appearance. No cells were found on microscopic examination of the CSF. CSF biochemistry revealed protein: 18 mg/dL, glucose: 75 mg/dL (concurrent blood glucose level: 102 mg/dL) and lactate dehydrogenase (LDH) < 30 U/L. A. baumannii was isolated from the CSF culture. Since all CSF parameters were within normal range and bedside CSF culture was not performed, a contamination was suspected, and LP was repeated. Follow-up LP also revealed normal CSF pressure, clear CSF, and no cells on microscopic examination. Biochemical examination revealed protein: 25.2 mg/dL, glucose: 84 mg/dL (concurrent blood glucose level: 118 mg/ dL) and, LDH: 44 U/L; A. baumannii grew on CSF culture. Growth on culture despite normal CSF findings prompted LP to be repeated once again. The last LP revealed normal CSF pressure and appearance and no cells on microscopic examination, but biochemical tests showed protein level of 25 mg/dL and glucose level of 82 mg/dL, with concurrent blood glucose level of 106 mg/dL. LDH was 30 U/L, and A. baumannii grew for the third time. The patient was diagnosed as acinetobacter meningitis, and treatment consisting of intrathecal and intravenous colistin together with meropenem was started. CSF culture after intrathecal colistin treatment on consecutive days yielded no growth. There was improvement regarding consciousness after this treatment. We emphasize that CSF culture is more valuable in the diagnosis of meningitis, and that meningitis, albeit rarely, can have an uncommon presentation.

Keywords

• Acinetobacter baumannii
• colistin
• meningitis
• head trauma