Bacterial Meningitis Despite 'Normal' CSF Findings

To the Editor.—Report of a Case.— A 50-year-old woman was admitted to the hospital because of fever, purulent sputum, dyspnea, and pleuritic pain; she had not taken antibiotics prior to admission. Her medical history was unremarkable. On admission her blood pressure was 80/50 mm Hg, her temperature was36.8 °C, her pulse rate was 120 beats per minute and regular, and her respirations were 28/min. Physical findings were normal except for bibasilar rales, and there were no signs of meningeal irritation. An x-ray film of the chest showed an alveolar pattern in both lower lobes and a rightsided pleural effusion. The blood picture profile was normal except for a leukocyte count of 20,300/cu mm with 18% band forms. Thoracocentesis disclosed serosanguineous fluid and a Gram-stained smear showed no organisms. Four hours later her temperature rose, her consciousness became impaired, and she developed mild nuchal rigidity without other focal neurologic signs.