Concurrent Vibrio cholerae O1 Meningitis and Intracranial Lesions in a Patient With Sickle Cell Disease: A Case Report

TL;DR

A patient with sickle cell disease developed rare cholera meningitis and brain lesions, showing the importance of quick diagnosis and treatment.

Contribution

This case report documents a rare instance of V. cholerae O1 meningitis with intracranial lesions in a sickle cell disease patient.

Findings

V. cholerae O1 was isolated from cerebrospinal fluid in a patient with sickle cell disease.

Brain imaging showed ring-enhancing lesions, initially suggesting tuberculomas.

Antituberculosis treatment and steroids improved the patient's condition.

Abstract

Cholera meningitis is a rare complication of Vibrio cholerae (V. cholerae) infection. We present a case of cholera meningitis caused by toxigenic V. cholerae O1 in a 34-year-old male with sickle cell disease (SCD). The patient presented with fever, diarrhea, and altered mental status. Cerebrospinal fluid (CSF) analysis showed 5,231 cells/μL (53.9% neutrophils), a protein level of 462 mg/dL, and a glycorrhachia level of 26 mg/dL. V. cholerae O1 was isolated on CSF culture. Despite the patient undergoing antimicrobial therapy, brain imaging revealed basal ganglia ring-enhancing lesions suggestive of tuberculomas. Antituberculosis treatment and steroids led to clinical improvement. This report highlights the need to consider V. cholerae meningitis in patients with SCD who present with diarrhea and altered mental status. Prompt diagnosis and appropriate antimicrobial therapy are keys to improving patient outcomes.

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