632. Recurrent Pneumococcal Meningitis in Adults

Abstract

Background. Recurrent pneumococcal meningitis is uncommon in adults. Underlying disorders include humoral immune defciency, cerebrospinal fuid (CSF) leaks, asplenia or cochlear implants. We evaluated two women who each had two separate episodes of Streptococcus pneumoniae meningitis. Both had histories of systemic lupus erythematosus (SLE). Methods. Immune evaluations were negative except for occasional Howell-Jolly bodies on their blood smears. Immunoglobulins were normal as were their post vaccine responses to pneumococcal polysaccharide vaccine-23 (Pneumovax®). Complement levels: C3, C4 and CH50 were normal. Lab but not clinical markers of SLE were present. In both patients, the spleen was anatomically present. In both, there was near absent splenic function on a heat damaged tagged RBC TC 99 m spleen scan. A literature search was carried out using Medline/PubMed and Google. Results. Streptococcus pneumonic infections make up about 6-18% of all bacterial infections in SLE; most are pneumonia. Although several cases of pneumococcal sepsis/shock have been reported in such patients, we could not fnd similar cases of recurrent pneumococcal meningitis in patients with inactive, untreated SLE. Conclusion. Recurrent pneumococcal meningitis is uncommon in adults and is usually associated with humoral immune defciency, CSF leaks or cochlear implants. Complement defciency (primary) is rarely found. Sickle cell disease and other hemoglo-binopathies have also been associated with pneumococcal sepsis and meningitis. SLE and other autoimmune connective tissue disorders are associated with functional asplenia, even when clinically inactive. Tese patients are at increased risk for invasive pneumococ-cal disease. Functional asplenia in adult patients is often overlooked in patients with severe or recurrent infections caused by polysaccharide encapsulated bacteria. We report on two patients with recurrent pneumococcal meningitis and SLE. Functional asplenia and complement defciency are the primary factors when such patients develop invasive or recurrent infections. Demonstration of a poorly functional spleen by a TC 99 heat denatured RBC spleen scan when the spleen is anatomically present confrms the diagnosis.