73-Year-Old Man Battles Bacterial Meningitis – Don't Ignore Unexplained Fever
When it comes to unexplained fevers, especially in older adults, it's crucial not to overlook the possibility of serious underlying conditions. This real-life case highlights the importance of timely diagnosis and treatment when symptoms like fever, headache, and altered mental status appear. The patient, a 73-year-old male, experienced a sudden onset of fever and neurological symptoms that ultimately led to a diagnosis of bacterial meningitis and multiple lacunar infarcts.
Case Overview
This case involves a 73-year-old male who was admitted to the Second Affiliated Hospital of Harbin Medical University in January 2022. He presented with fever, headache, nausea, and altered mental status. After a series of diagnostic tests including MRI, lumbar puncture, blood culture, and routine blood work, he was diagnosed with bacterial meningitis accompanied by multiple lacunar infarcts. He underwent a 10-day inpatient treatment plan and made a full recovery with no signs of recurrence after one month.
Initial Presentation and Diagnosis
About 13 days before hospitalization, the patient began experiencing unexplained fever with temperatures ranging between 37 and 39 degrees Celsius. He also suffered from a persistent headache, a feeling of pressure throughout the head, and nausea. Five days prior to admission, he started showing signs of mental confusion—responding slowly to questions, falling asleep quickly after being roused, and experiencing episodes of incontinence. Despite being able to move his limbs, he was clearly unwell.
Upon admission, he underwent a comprehensive diagnostic evaluation. His sleep quality was poor, and his appetite was significantly reduced. A full neurological workup was initiated, including MRI of the head, lumbar puncture, and blood tests to determine the underlying cause of his symptoms.
Treatment Plan and Medical Findings
During the physical examination, the patient was alert but apathetic. His pupils were equal in size and reactive to light. He exhibited neck stiffness, a positive Brudzinski's sign, and positive pathological reflexes in both lower limbs. No facial paralysis or tongue deviation was observed.
Imaging and lab results revealed multiple lacunar infarcts on MRI, with no diffusion restrictions on DWI sequences. Cerebrospinal fluid (CSF) analysis from the lumbar puncture showed reduced glucose (2.5 mmol/L) and chloride (125.0 mmol/L), elevated protein (879 mg/L), and a cell count of 40. The CSF opening pressure was 245 mmH₂O, indicating increased intracranial pressure.
Based on these findings, the patient was diagnosed with bacterial meningitis coexisting with multiple lacunar infarcts. His treatment regimen included intravenous mannitol to reduce intracranial pressure, Xingnaojing (a traditional Chinese medicine used for brain protection), ceftriaxone for antibiotic therapy, and intravenous immunoglobulin (IVIG) for immune support.
Recovery and Follow-Up
After 10 days of targeted treatment, the patient's fever and headache significantly improved, and his body temperature returned to normal. His vital signs remained stable, with no abnormal heart rate, blood pressure, or respiratory patterns observed. His mental clarity improved, and he was able to communicate effectively.
He was discharged with no adverse drug reactions and was advised to rest and stay hydrated. During a one-month outpatient follow-up, there were no signs of relapse, and his condition remained stable. This outcome underscores the effectiveness of timely and appropriate medical intervention.
Post-Treatment Care and Recommendations
While the patient made a full recovery, it's essential to emphasize the importance of continued care and lifestyle adjustments. Family members were advised to create a supportive living environment, ensure proper ventilation in the home, and avoid exposing the patient to extreme temperatures or other environmental stressors.
In addition, the patient was encouraged to maintain a positive mindset, manage emotional stress, engage in gentle physical activity, and follow a nutrient-rich diet to support immune function and overall health.
Key Takeaways for Health Awareness
Bacterial meningitis often presents with fever and neurological symptoms such as confusion or behavioral changes. Diagnostic lumbar puncture typically reveals low glucose and chloride levels in the CSF, elevated protein, and increased opening pressure. While awaiting culture results, empirical antibiotic therapy is initiated, often using agents like ceftriaxone that can effectively cross the blood-brain barrier.
Long-term antibiotic use requires monitoring for secondary infections, particularly fungal infections. Close observation of vital signs, mental status, and inflammatory markers like CRP and WBC is essential during hospitalization to prevent disease progression.
This case serves as a reminder that unexplained fever, especially when accompanied by neurological symptoms, should never be ignored. Prompt medical attention can make the difference between a full recovery and life-threatening complications.