Young Man Recovers from Acute Meningitis Following Targeted Medical Treatment

Overview: A Case of Successful Recovery from Acute Meningitis

Acute meningitis is a serious neurological condition characterized by inflammation of the protective membranes covering the brain and spinal cord. This case study highlights the journey of a 34-year-old male who presented with severe headache and fever, later diagnosed with acute meningitis following clinical evaluation and cerebrospinal fluid analysis. Early detection, prompt hospitalization, and an effective combination therapy played crucial roles in his recovery. With appropriate antimicrobial, antiviral, and neuroprotective treatments, the patient showed significant improvement within 10 days and was discharged with stable vital signs and normalized lab results.

Patient Profile & Clinical Background

Age & Gender: 34-year-old maleDiagnosis: Acute Meningitis (likely bacterial-viral co-infection)Hospital: Second Affiliated Hospital of Harbin Medical UniversityDate of Admission: January 2022Treatment Duration: 10-day inpatient careTherapeutic Approach: Combination drug therapy including Ceftriaxone sodium, Ganciclovir, Cerebroprotein Hydrolysate, Mannitol, Xingnaojing injection, and Lingyangjiao capsulesOutcome: Full resolution of symptoms; successful discharge after meeting clinical recovery criteria

Initial Presentation: Recognizing the Warning Signs

The patient first experienced sudden-onset fever and intense headaches three days prior to hospitalization. His body temperature peaked at 39.5°C, accompanied by throbbing pain in the bilateral temporal and frontal regions—so severe that he described it as feeling like his head would "explode." Additional symptoms included nausea and three episodes of projectile vomiting containing gastric contents. Notably, there were no signs of limb weakness, speech difficulties, or seizures, which initially led him to mistake the condition for a common cold.

Despite self-medicating with over-the-counter cold remedies, his headache persisted. When symptoms failed to improve, he sought medical attention with family support. A non-contrast head CT scan revealed no structural abnormalities, ruling out hemorrhage or mass lesions. However, given the severity and nature of the symptoms, physicians recommended hospital admission for further diagnostic workup, which the patient accepted after informed consent.

Diagnostic Evaluation and Confirmation

Upon admission, physical examination showed the patient was alert and oriented with normal speech. Vital signs included a temperature of 37.9°C, blood pressure of 130/85 mmHg, heart rate of 71 bpm, and respiratory rate of 19 breaths per minute. Neurological assessment revealed positive meningeal signs: neck stiffness (nuchal rigidity), Kernig's sign, and Brudzinski's sign—all classic indicators of meningeal irritation.

To confirm the diagnosis, advanced imaging and laboratory tests were conducted:

• Brain MRI: Revealed small ischemic foci within the cerebral parenchyma.
• EEG (Electroencephalogram): Showed borderline electrical activity, suggesting mild cortical dysfunction.
• Lumbar Puncture: Critical for definitive diagnosis. Results showed elevated opening pressure (280 mmH₂O), low glucose (2.67 mmol/L), slightly reduced chloride (124.0 mmol/L), elevated protein (1027 mg/L), and increased white cell count (20 cells/μL)—consistent with acute inflammatory meningitis.

Based on these findings and absence of known allergies to cephalosporins or penicillins, a multidrug regimen was initiated targeting both bacterial and viral pathogens while also managing intracranial pressure and supporting brain metabolism.

Comprehensive Treatment Strategy

A tailored treatment plan was implemented to address infection, reduce cerebral edema, protect neural tissue, and alleviate symptoms:

Antibiotic Therapy

Ceftriaxone Sodium Injection: A third-generation cephalosporin chosen for its excellent penetration across the blood-brain barrier, providing broad-spectrum coverage against common meningitis-causing bacteria such as Streptococcus pneumoniae and Neisseria meningitidis.

Antiviral Support

Ganciclovir Injection: Administered due to suspicion of possible viral involvement, particularly herpesviruses, which can mimic bacterial meningitis and require specific antiviral intervention.

Neuroprotection & Brain Metabolism Enhancement

Cerebroprotein Hydrolysate: Used to enhance neuronal repair and support cognitive function during recovery.

Xingnaojing Injection: A traditional Chinese medicine formulation with documented sedative and neuroprotective effects, used adjunctively to stabilize consciousness and reduce neuroinflammation.

Intracranial Pressure Management

Mannitol Injection: Employed as an osmotic diuretic to decrease cerebral edema and lower intracranial pressure, helping prevent complications such as brain herniation.

Symptomatic Relief

Lingyangjiao Capsules: Prescribed orally to help relieve residual headache and promote calmness through natural antipyretic and analgesic properties.

This integrated approach ensured comprehensive management of both underlying causes and systemic manifestations of the disease.

Positive Clinical Response and Discharge Outcome

After 10 days of intensive in-hospital care, the patient demonstrated marked clinical improvement:

• Fever resolved completely; body temperature stabilized within normal range.
• Headache intensity significantly decreased—only occasional mild pulsating discomfort remained in the temples.
• No further episodes of nausea, vomiting, or neurological deficits observed.

A follow-up lumbar puncture confirmed substantial improvement in cerebrospinal fluid parameters:

• CSF glucose: Improved to 2.88 mmol/L
• CSF chloride: 121.0 mmol/L
• Opening pressure: Reduced to 180 mmH₂O
• Protein level: Dropped to 329 mg/L
• White cell count: Normalized to 5 cells/μL

These results indicated effective control of infection and resolution of meningeal inflammation. The treating team determined that the patient met all discharge criteria and approved his release with detailed post-care instructions.

Post-Discharge Guidance for Long-Term Wellness

While most patients recover fully from acute meningitis without long-term consequences, ongoing vigilance is essential:

Monitor Body Temperature

Mild elevations in temperature (below 38.5°C) should not be aggressively suppressed, as they represent the body's natural immune response. However, high fevers require timely intervention using both physical cooling methods (cool compresses, hydration) and antipyretic medications to prevent febrile seizures.

Watch for Neurological Changes

Family members should remain alert for any changes in mental status, confusion, agitation, or seizure activity—potential signs of residual brain injury or relapse. Immediate medical evaluation is necessary if such symptoms arise.

Prevent Complications During Vomiting Episodes

If nausea returns, ensure the patient turns their head to one side during vomiting to prevent aspiration. Promptly clear oral secretions and seek emergency care if symptoms persist or worsen.

Follow-Up Testing

Repeat lumbar puncture may be advised after several weeks to confirm complete normalization of CSF markers, especially in cases where initial presentation was severe.

Clinical Insights and Broader Implications

This case underscores the importance of early recognition and rapid intervention in acute meningitis. Symptoms may initially resemble common viral illnesses but can progress rapidly to life-threatening conditions. Key red flags include severe headache, photophobia, neck stiffness, and projectile vomiting.

Differential diagnoses must include other causes of headache such as post-infectious syndromes, subarachnoid hemorrhage, migraines, and tension-type headaches. Accurate diagnosis relies heavily on lumbar puncture and neuroimaging.

Luckily, the majority of patients respond well to treatment and achieve full recovery within 2–3 weeks. However, delayed diagnosis increases the risk of complications such as hearing loss, cognitive impairment, or epilepsy. Therefore, public awareness and access to timely healthcare are critical.