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Images in Neurology
December 2007

Vasculitic Presentation of Staphylococcal Meningitis

Arch Neurol. 2007;64(12):1788-1789. doi:10.1001/archneur.64.12.1788

A 19-year-old man had a 3-day history of headache, vomiting, and confusion. At admission, he was agitated, with bilateral papilledema, splinter hemorrhages, conjunctival and palatal petechiae, and distal purpura (Figure, A). His temperature was 38.3°C; pulse rate, 94/min; and blood pressure, 95/57 mm Hg. The C-reactive protein level was 303 mg/mL (to convert to nanomoles per liter, multiply by 9.524). Computed tomographic scans of the brain revealed hemorrhagic infarction in the right parietal lobe. At lumbar puncture, the white blood cell count was 62/μL (to convert to × 109/L, multiply by 0.001) (30% polymorphonuclear leukocytes), protein concentration was 0.05 g/dL (to convert to grams per liter, multiply by 0.001), and plasma glucose concentration was 64%. The results of cerebrospinal fluid culture and meningococcus polymerase chain reaction were negative. Blood cultures grew Staphylococcus aureus that was sensitive to methicillin. Transesophageal echocardiograms on days 3, 5, and 6 showed no evidence of endocarditis.