Abstract Details

Title Salmonella Meningitis and Infectious Myelitis in an Immunocompetent Patient with Marfan Syndrome

Topic Infectious Disease

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-013

Objective To discuss a case of Salmonella meningitis and myelitis in an immunocompetent patient with history of Marfan Syndrome.

Background NA

Design/Methods NA

Results

A 58-year-old German man with history of Marfan syndrome, aortic aneurysm repair, mechanical aortic valve on warfarin, and subdural hemorrhage status post middle meningeal artery (MMA) embolization, presented with two days of chest pain and leg weakness concerning for aortic dissection. Shortly after presentation, he became obtunded requiring intubation. CT aortography was without recurrent aneurysm, but CT head demonstrated hydrocephalus and hyperdensities concerning for subarachnoid hemorrhage (SAH). A right frontal external ventricular drain was placed.

Blood cultures and CSF returned positive for Salmonella enterica. MRI brain showed diffuse leptomeningeal enhancement and FLAIR signal abnormalities concerning for leptomeningitis, with innumerable microhemorrhages and superficial siderosis. Blood and CSF cultures cleared on hospital days 2 and 10 respectively, and dual coverage with cefepime and levofloxacin was narrowed to ceftriaxone. As mental status improved, the patient demonstrated lower extremity paralysis and areflexia, raising concern for transverse myelitis versus spinal cord ischemia. MRI showed abnormal longitudinal T2 hyperintense signal about the surface of the cord, however endovascular aortic grafts limited interpretability of spinal DWI. Catheter angiography revealed a high flow dural arteriovenous fistula (dAVF) draining into the left frontal cortical veins that was embolized on hospital day 15.

Conclusions We present a challenging case of salmonella meningitis and myelitis, a rare entity in an immunocompetent patient without clear exposure history. Though initial imaging was concerning for aneurysmal SAH, this likely reflected prior contrast administration in combination with infectious meningitis. Myelitis related to bacterial meningitis is a rare complication for which treatment is mainly supportive. Here, prior aortic repair and septic shock may have led to an expanded cord watershed and ischemia. The dAVF was likely incidental and may have been related to prior MMA embolization.

Authors/Disclosures
Phillip Perez PRESENTER	Mr. Perez has nothing to disclose.
Holly Herman, Medical Student	Ms. Herman has nothing to disclose.
James A. Belarde, MD, PhD	Dr. Belarde has nothing to disclose.
Tarini Goyal	Dr. Goyal has nothing to disclose.
Michael Phillips, MD	Dr. Phillips has nothing to disclose.
Caleb Rutledge, MD	Dr. Rutledge has nothing to disclose.
Benjamin Brush, MD (NYU Langone Neurology)	Dr. Brush has nothing to disclose.
Wells Andres, MD	Dr. Andres has nothing to disclose.

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