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In adults, Streptococcus pneumoniae often reflects an anatomic breach such as post-traumatic encephalocele with CSF rhinorrhea, whereas Neisseria suggests complement deficiency. A 22-year-old man presented with his second pneumococcal meningitis episode within one year after a road traffic accident. Imaging and cultures supported a post-traumatic left frontal encephalocele and confirmed S. pneumoniae; he was treated with antibiotics, with endoscopic repair and vaccination recommended to prevent further recurrences.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/recurrent-pneumococcal-meningitis-from-post-traumatic-frontoethmoidal-encephalocele-a-case-report/461768/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/recurrent-pneumococcal-meningitis-from-post-traumatic-frontoethmoidal-encephalocele-a-case-report/461768.png","ImageObject",300,407,{"name":92,"@type":93},"Jiven","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",18,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What definition guides the evaluation of recurrent bacterial meningitis in adults?","Question",{"text":113,"@type":114},"Recurrent bacterial meningitis refers to at least two episodes with complete recovery between episodes, which warrants assessment for skull-base defects with CSF leak and for immune deficiencies.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Why does Streptococcus pneumoniae suggest an anatomic breach in adults?",{"text":118,"@type":114},"The article notes that Streptococcus pneumoniae commonly indicates an anatomic breach such as post-traumatic encephalocele with CSF rhinorrhea.",{"name":120,"@type":111,"acceptedAnswer":121},"What key management steps help prevent further episodes in adult recurrent pneumococcal meningitis?",{"text":122,"@type":114},"Prompt skull-base imaging for occult CSF leak/encephalocele and parallel immune evaluation are emphasized, with definitive endoscopic repair and pneumococcal vaccination recommended to prevent further recurrences.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},461768,1790792104,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},1099513958607,"https://ap-avatar.wpscdn.com/avatar/100002390cf8733938c?x-image-process=image/resize,m_fixed,w_180,h_180&k=1778829742770036399","Review began 11/04/2025  \nReview ended 12/05/2025  \nPublished 12/10/2025  \n© Copyright 2025  \nMazen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98862  \nOpen Access Case Report  \nRecurrent Pneumococcal Meningitis From Posttraumatic Frontoethmoidal Encephalocele: A Case Report  \nYazan Mazen 1, 2, Ahmed Darweesh 2, Maryam Al Ani 2, Nada Alfalasi 2, Asif Mohamed Salim 2, Leena Abdelrahman 2  \n1. Medicine, University of Sharjah, Sharjah, ARE 2. Internal Medicine, Dubai Hospital, Dubai Health, Dubai, ARE Corresponding author: Yazan Mazen, [yazanmelhem2001@gmail.com](yazanmelhem2001@gmail.com)  \nAbstract  \nRecurrent bacterial meningitis (≥2 episodes with complete recovery between episodes) warrants evaluation for skull-base defects with cerebrospinal fluid (CSF) leak and for immune deficiencies. In adults, Streptococcus pneumoniae often indicates an anatomic breach (e.g., post-traumatic encephalocele/CSFrhinorrhea), whereas Neisseria suggests complement deficiency. We report a case of a 22-year-old man with his second attack of pneumococcal meningitis within a one-year timeframe after sustaining a road traffic accident about four years ago. The patient sustained a left frontal bone fracture communicating with the left frontal sinus, along with a left frontal encephalocele. His current complaint was fever and cough of one week duration; they were associated with headache, rhinorrhea, vomiting, sore throat, fatigue, and generalized body pain. The patient denied having any past history of recurrent or severe infections, especially during childhood and adulthood. Upon assessment, his temperature was 37.6 °C, and his vitals were within normal limits. Physical examination was remarkable for positive neck stiffness. Otherwise, no skin rashes were noted ; neurological assessment included a Glasgow Coma Scale of 15/15, no focal neurological deficits, and intact cranial nerves. His abdomen was soft, lax, and non-tender; his spleen was not palpable. Labs were significant for leukocytosis, elevated inflammatory markers, hypoglycorrhachia, and elevated CSF protein. Both blood and CSF cultures were positive for S. pneumoniae. His HIV test was negative. He was empirically treated with IV ceftriaxone and vancomycin, and later tailored to ceftriaxone after the cultures’susceptibility results were out. In adults with recurrent pneumococcal meningitis, prompt skull-base imaging for occult CSF leak/encephalocele, and parallel immune evaluation are essential. Definitive endoscopic repair plus pneumococcal vaccination can prevent further episodes. Structured pathways that trigger beta-2 transferrin testing and high-resolution CT/MRI after a second episode may reduce diagnostic delay.  \nCategories: Neurology, Anatomy, Internal Medicine  \nKeywords: csf leak, encephalocele, endoscopic repair, recurrent bacterial meningitis, skull defects, streptococcus pneumoniae  \nIntroduction  \nMeningitis is defined as inflammation of the meninges, the layers covering the brain and spinal cord. The most common causes of meningitis are bacterial and viral [1] . Most common causes of bacterial meningitis in patients older than one month of age (i.e., neonates) are Streptococcus pneumoniae and Neisseria meningitidis, accounting for more than 70% of bacterial meningitis cases in Europe, and 10-20% of the cases in the United States. Both are associated with high mortality rates, with S. pneumoniae having a higher rate compared to the latter. S. pneumoniae had case fatality rates of 20-37% in high-income countries, versus approximately half of the fatality cases in low-income countries; N. meningitidis was associated with 3% in high-income countries, and 10% in low-income countries [2] . In addition, pneumococcal meningitis had an overall higher r","cbCaimvRoDRG2e2B","https://ap.wps.com/l/cbCaimvRoDRG2e2B","pdf",5479529,"English","# Abstract\n# Introduction\n## Definitions and causes of recurrent meningitis\n## Encephaloceles and risk of recurrent meningitis\n# How to cite this article","[{\"question\":\"What definition guides the evaluation of recurrent bacterial meningitis in adults?\",\"answer\":\"Recurrent bacterial meningitis refers to at least two episodes with complete recovery between episodes, which warrants assessment for skull-base defects with CSF leak and for immune deficiencies.\"},{\"question\":\"Why does Streptococcus pneumoniae suggest an anatomic breach in adults?\",\"answer\":\"The article notes that Streptococcus pneumoniae commonly indicates an anatomic breach such as post-traumatic encephalocele with CSF rhinorrhea.\"},{\"question\":\"What key management steps help prevent further episodes in adult recurrent pneumococcal meningitis?\",\"answer\":\"Prompt skull-base imaging for occult CSF leak/encephalocele and parallel immune evaluation are emphasized, with definitive endoscopic repair and pneumococcal vaccination recommended to prevent further recurrences.\"}]","Recurrent Pneumococcal Meningitis From Post-traumatic Frontoethmoidal Encephalocele - A Case Report | PDF",1790762381,25]