# Fulminant Multidrug-Resistant Streptococcus pneumoniae Meningoencephalitis After Elective ENT Surgery: A Case Report

## TL;DR

A man developed severe meningitis after ENT surgery, caused by drug-resistant bacteria, highlighting the importance of vaccination and prompt treatment.

## Contribution

This case report highlights a rare postoperative complication of MDR Streptococcus pneumoniae meningoencephalitis and emphasizes the role of vaccination in prevention.

## Key findings

- A 41-year-old man developed fulminant MDR S. pneumoniae meningoencephalitis 48 hours after septoturbinoplasty.
- Empirical therapy with vancomycin and meropenem, along with corticosteroids and ICU care, led to full neurological recovery.
- The case underscores the importance of pneumococcal vaccination in high-risk surgical patients to prevent catastrophic infections.

## Abstract

Pneumococcal meningoencephalitis is a severe infection associated with high morbidity and mortality. Although typically community-acquired, postoperative cases following elective ENT surgery are exceedingly rare. Antimicrobial resistance (AMR) among Streptococcus pneumoniae further complicates management, and missed opportunities for vaccination represent preventable risks. We report a case of a 41-year-old man with multiple comorbidities who developed fulminant S. pneumoniae meningitis 48 h after septoturbinoplasty. The clinical course was atypical, with altered consciousness but no classical meningeal signs, necessitating urgent intubation and intensive care admission. Cerebrospinal fluid cultures identified an MDR pneumococcal strain resistant to penicillin and macrolides but susceptible to vancomycin and meropenem. Empirical therapy with vancomycin and meropenem, combined with adjunctive corticosteroids and multidisciplinary ICU care, led to complete neurological recovery. This case highlights a rare but life-threatening postoperative complication and underscores two critical lessons. First, the growing challenge of multidrug-resistant pneumococcus requires timely recognition, aggressive empiric therapy, and access to effective agents. Second, the absence of pneumococcal vaccination in this high-risk surgical patient illustrates a preventable gap in care. Integrating vaccination screening into preoperative evaluations may reduce the risk of catastrophic postoperative CNS infections.