Pseudomonas aeruginosa meningitis after visiting a swimming pool: a complicated dive

Community-acquired meningitis caused by P. aeruginosa is rare and has a very high mortality rate. Early recognition and treatment is of paramount importance. We describe a case of a 75-year-old male with a P. aeruginosa meningitis which was linked to a regional swimming pool. Physicians should be aware that treatment according to the Dutch meningitis guidelines does not include coverage of infection with P. aeruginosa, which can cause, as in our case, a significant treatment delay. The case was complicated by endocarditis of an aortic valve bio-prosthesis and illustrates the incremental value of a PET-CT scan in case of high clinical and microbiological suspicion for endocarditis, while having negative echocardiographic findings.