To describe a case report of ESBL E. Coli Meningitis and VZV Encephalitis with cerebral vasculopathy and embolic stroke in a patient with HIV/AIDS. 

Patients with HIV are known to have increased chances of community acquired meningitis, however the epidemiology of each case of infection varies significantly with the type of host. Our patient presented with symptoms secondary to ESBL E.Coli Meningitis with spontaneous onset. This is a rarely reported condition worldwide, with only 45 cases of community-acquired E. coli meningitis reported between 1946 and 2017. Furthermore, our patient also was identified to have Varicella-Zoster virus (VZV) vasculopathy. Current literature recommends that HIV patients with CD4 counts less than 200, with diagnosed herpes zoster should be monitored carefully for neurological symptoms.

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This case illustrates that patients with HIV/AIDS who develop neurologic deficits, require a complex workup to identify the origin. Medication non-compliance plays a significant role in making HIV patients vulnerable to spontaneous bacterial meningitis infections, such as our patient with E.coli. Furthermore, VZV encephalopathy with ventriculitis leads to progressive neurologic decline, with potential for new embolic stroke. It is pertinent to continue to develop guidelines for neurologic management of HIV patients with bacterial meningitis and viral vasculopathy.