Meningitis with pneumocephalus originating from a sacral pressure ulcer.

An 86-year-old woman with a sacral pressure ulcer who was in a bedridden state due to terminal dementia was admitted complaining of a headache and fever. She showed an impaired consciousness and meningeal irritation without any other neurological deficits. A cerebrospinal fluid examination revealed leukocytosis (2,500/mm, 92% polymorphs) and hypoglycorrhachia. Head computed tomography (CT) findings showed multiple air bubbles in the subarachnoid space and the ventricles (Picture 1). The sacral pressure ulcer contained exposed bone, but the dura mater was not visible. The leakage point could not be detected macroscopically (Picture 2a). Spinal CT revealed the presence of a pneumatocele in the spinal canal. In addition, the terminal of the spinal canal formed a fistula at the sacral region through the thin bone cortex (Picture 2b, arrow). These findings were totally resolved following the treatment, which included antimicrobial administration, of the pressure ulcer. We herein report the first case of bacterial meningitis with pneumocephalus where direct radiological evidence is presented concerning the communication between the external air and the spinal canal through a pressure ulcer (1, 2).