A54-22 A Fatal Triad: Concurrent Ventriculitis, Encephalitis and Meningitis

Abstract Introduction Encephalitis, ventriculitis, and meningitis are well-known neurologic complications secondary to an infection which can periodically present with two out of three manifestations, typically in high-risk individuals such as neonates and neurosurgical patients. There are no documented cases of the simultaneous presentation of all three conditions in a single patient posing significant challenges from a diagnostic and management standpoint. We present a case of an adult male with no surgical history who had concurrent encephalitis, ventriculitis and meningitis. Case Presentation A 73-year-old male with a history of hypertension, hyperlipidemia, and alcohol use disorder was airlifted from a cruise ship for acute encephalopathy and respiratory distress from COVID-19. On arrival, the patient was already on antibiotics for community acquired pneumonia, however, with persistent leukocytosis and hypertensive with an SBP 200 mmHg. Initial head CT was negative for any acute abnormalities, so antibiotics were continued, blood pressure control initiated, and supportive care provided for acute alcohol withdrawal. Several days later, a stroke alert was called for sustained left-sided weakness and worsening encephalopathy, prompting transfer to the ICU and intubation for airway protection. A lumbar puncture revealed findings suggestive of meningitis with purulent CSF and an opening pressure of 24 mmHg prompting immediate escalation of antibiotics. MRI of the brain revealed simultaneous ventriculitis, meningitis, and encephalitis. Neurosurgery was consulted; however, intervention was not indicated at that time. Lumbar puncture serologies remained negative, presumably due to ongoing antibiotics and lag time from symptom onset. A repeat CT brain days later revealed ischemic infarcts in the right middle and anterior cerebral artery territories. Following progressive neurologic decline and no improvement over the next week, his spouse opted to transition him to hospice and palliative extubation. Conclusion Early identification and appropriate antibiotic coverage remain as the mainstay treatment for conditions with infectious etiologies with surgical intervention when appropriate. The simultaneous presence of meningitis, encephalitis, and ventriculitis with stroke is infrequent, emphasizing the significance of broad differentials and importance of implementing comprehensive management strategies. This abstract is funded by: None