Abstract Details

Title Pseudomonas Meningoencephalitis Stemming From Occult Chronic Sacral Abscess

Topic Infectious Disease

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-003

Objective To describe a case of meningoencephalitis causing confusion initially attributed to prior stroke and active UTI.

Background Altered mental status (AMS) can occur due to a wide variety of both chronic and acute pathologies. Often, the etiology of a patient’s AMS is apparent—other times, it may be more subtle. In this case, we describe a case of AMS initially attributed to the patient’s chronic cerebrovascular disease and UTI, found later to be due to meningoencephalitis caused by an uncommon organism, Pseudomonas aeruginosa.

Design/Methods case report

Results Our patient is a female with a history of thalamic hemorrhage who initially presented for AMS, found to have Psuedomonas bacteremia and UTI; she was treated with antibiotics and discharged. She presented one month later with worsening confusion; neurology was thusly consulted. She was found to have a worsening UTI and small subacute multifocal cerebral infarcts. Her AMS was initially attributed to these findings. An EEG was performed, demonstrating diffuse cerebral dysfunction. An LP demonstrated 4,330 nucleated cells (79% PMNs) and culture positivity for Pseudomonas. An MRI of the Lumbar spine demonstrated chronic sacral abscess. One month prior to her initial presentation, she had undergone spinal pain pump placement which was removed due to Staphylococcal infection. It is believed that the post-operative site was colonized by Pseudomonas, leading to her subsequent infections, including meningoencephalitis. She promptly improved after sensitivity-directed antibiotic therapy.

Conclusions Over 50% of bacterial meningoencephalitides are attributed to Staphylococcus and Neisseria species, with Pseudmonas accounting for a remarkably small percent, with the exception of strict considerations of individuals with nosocomial meningoencephalitis, of which Pseudomonas is a common culprit. Both the search for a source and empiric treatment must be broadened in those who have undergone neurosurgery, penetrating skull trauma, skull fractures or prolonged hospitalizations, as these patients are more likely to develop uncommon sources of infection.

Authors/Disclosures
Connor D. Welsh, DO (Barrow Neurological Institute) PRESENTER	Dr. Welsh has nothing to disclose.
Tejas Ranade, MD (10th Medical Group)	Dr. Ranade has nothing to disclose.
Elizabeth Anderson, MD (Barrow Neurological Institute)	Dr. Anderson has nothing to disclose.

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