Rampant spread of infection in an afebrile immune-competent patient presenting with young-onset ischaemic stroke

A 27-year-old healthy woman developed spontaneous right-sided orbital cellulitis, followed by left hemiparesis and cranial nerve palsies. MRI revealed underlying basal exudates and vasculitic infarction involving the pons and cerebellar peduncles, following which a cerebrospinal fluid examination co...

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Bibliographic Details
Published in:BMJ case reports 2020-08, Vol.13 (8), p.e235495
Main Authors: Arora, Umang, Ray, Animesh, Vyas, Surabhi, Vikram, Naval Kishore
Format: Article
Language:English
Subjects:
Acoustics
Adult
Antibiotics
Ataxia
Case reports
Cellulitis
Diabetes
Female
Humans
Immunocompetence
Ischemia
Ischemic Stroke - microbiology
Kidneys
Klebsiella Infections - complications
Klebsiella pneumoniae
Lungs
Meningitis
Meningitis, Bacterial - complications
Meningitis, Bacterial - microbiology
Neuroimaging
Neurological disorders
Neutrophils
Pneumonia
Proteins
Sinuses
Streptococcus infections
Stroke
Unusual Association of Diseases/Symptoms
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Summary:A 27-year-old healthy woman developed spontaneous right-sided orbital cellulitis, followed by left hemiparesis and cranial nerve palsies. MRI revealed underlying basal exudates and vasculitic infarction involving the pons and cerebellar peduncles, following which a cerebrospinal fluid examination confirmed acute bacterial meningitis. Although the patient remained afebrile, imaging revealed asymptomatic septic foci in bilateral lungs, empyema and pyelonephritis. Blood culture grew drug-resistant Klebsiella pneumoniae. The case highlights the absence of fever in an immune-competent patient presenting with young-onset stroke secondary to meningitis.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-235495