A Case of Methicillin-resistant Staphylococcus Aureus Meningitis in Post-lumbar Drain Removal Presenting With Cervical Myalgia

Abstract

Hospital-acquired meningitis is a rare condition with high mortality if left untreated. We present a case of a 58-year-old male with a history of prior craniectomy and aneurysmal clipping from ruptured aneurismal subarachnoid hemorrhage who presented with a two-day onset of posterior auricular surgical wound site fluid leakage. Physical exam was significant for wound dehiscence leaking clear fluid. CT brain showed anew air cavity communicating from the occipital skin to the third and lateral ventricles. MRI brain revealed ruptured pseudo meningocele with pneumocephalus. Neurosurgery placed a lumbar drain; CSF leakage subsided, and the drain was removed. He developed afebrile cervicalgia one day after the drain removal. A neurological exam revealed neck stiffness and positive Kernig’s sign. CSF profile showed neutrophilic pleocytosis with low glucose. MRI Brain and cervical spine with contrast revealed new perioccipital leptomeningeal enhancement with fluid collection and pseudo meningocele. CSF culture grew MRSA. Daptomycin was initiated for treatment. His neck pain improved, and he was discharged with a four-week course of daptomycin. Our case demonstrates the importance of considering hospital-acquired meningitis in patients who have vague symptoms with a history of neurologic intervention. Early detection of hospital-acquired MRSA meningitis can prevent further complications.