Acute Pyogenic Meningitis: An Autopsy Case Report
Abstract
Acute pyogenic meningitis may be complicated by tonsillar herniation and this makes the clinical management of the patient very arduous and may to death. We report a case of a 13-year-old female admitted to the children emergency unit due to meningitis secondary to lobar pneumonia. The autopsy showed central cyanosis, lobar pneumonia, cerebral oedema, exudate around the brain, cerebral oedema and tonsillar herniation. Brain smear revealed numerous gram-positive cocci in chains. The cause of death was tonsillar herniation secondary to acute pyogenic meningitis.
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Introduction
A 13-year-old-female who was admitted to the Emergency ward with complaints of non-paroxysmal cough, difficulty in breathing and fever of a week duration. She also complaint of headache of two days duration and loss of consciousness of a day duration. There is no history of trauma.
She was acutely ill-looking, anicteric, moderately pale and with central cyanosis. Her neck was stiff and her respiratory rate was 14cpm (20-25 breaths/minute), pulse rate 66bpm (75-110bpm), temperature 39 degrees celcius (35.9-37.6o Celcius) and blood pressure was 140/100mmHg. She was unconscious and with a glassgow coma scale of 4/15(eye opening=1, best motor response=2, best verbal response=1). She was in marked respiratory distress. There was reduced air entry over the lung fields and few basal crepitation which were more prominent over the left lungs. Physical examination of other systems was normal.
The laboratory work up revealed a hemoglobin of 9.0g/dl (Reference Value {RV}: 11.5-16.5g/dl). Her random blood sugar was 8.0mmol/l (RV: below 11.1mmol/l). Her thick and thin blood film for malaria parasite was negative.
She received start doses of intravenous mannitol, ceftriazone, paracetamol and artesuanate. She was intubated and placed on mechanical ventilation. She also received intranasal oxygen. Her clinical condition kept on deteriorating and with a glasgow coma scale of 3/15. Her respiration was also deteriorating and she was gasping for air. She was noticed to have stopped breathing about 90 minutes after admission and despite attempts at resuscitation. She was certified dead and her body was moved to the morgue for autopsy. She was managed as a case of meningitis on background lobar pneumonia.
Conclusion
Acute pyogenic meningitis may lead to death, especially in the presence of a fatal complication like tonsillar herniation which obviously played key role in the demise of the patient. The autopsy was essential to clarify the cause of death in this young patient.