A case of fulminant Bacillus cereus meningoencephalitis after neuroplasty with white matter change

Bacillus cereus meningitis can show unusual presentation and very rapid progression associated with high mortality and unusual MRI findings. We report a 77-year-old man with fever and altered mentality after epidural neuroplasty for chronic lumbar spinal pain. Symptoms rapidly progressed over the 12 hours following surgery. He was diagnosed with meningoencephalitis by Bacillus cereus confirmed by CSF culture and DNA sequencing. He improved with antibiotics slowly although his mental state did not completely revert to his prior level. This case demonstrates the rapid and fulminant clinical picture produced by Bacillus cereus associated with neuroplasty. It also shows peculiar frontal white matter changes with hydrocephalus on MRI. Neurology Asia 2013; 18(3) : 315 – 317 Address correspondence to: SangYun Kim, MD, PhD, Clinical Neuroscience Center, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundanggu, Seongnam-si, Gyeonggi-do 463-707, Korea. Tel: 82-31-787-7462, Fax: 82-31-719-6815, E-mail: [email protected] INTRODUCTION Bacillus cereus is an aerobic or facultatively anaerobic, gram positive, spore-forming rod which rarely causes fulminant meningoencephalitis and primarily results in foodborne gastro-enteritis due to a pre-formed enterotoxin. It is an environmental organism commonly found in soil, vegetation and rice frequently associated with contamination. However it plays a role as pathogen for various local and systemic infections. It is associated with pan-ophthalmitis, endocarditis, pneumonia, meningitis and septic arthritis. Further, it can be an opportunistic pathogen, causing infections in immunologically compromised patients. We describe a fulminant case of meningoencephalitis caused by B. cereus in a patient who underwent neuroplasty. The infection was treated but improvement was incomplete.