This case highlights the importance of considering rare neurological complications in cases of severe meningitis in patients who are immunocompromised, and recognising CVSTs as a rare but potentially fatal complication in those with pneumococcal meningitis.
A man in his 40s on adalimumab for Crohn's disease developed severe Streptococcus pneumoniae meningitis presenting with fever, headache, agitation, and reduced consciousness.
Neurological imaging revealed extensive cerebral venous sinus thromboses (CVSTs) as a complication of pneumococcal meningitis.
The patient was treated with anticoagulation, antibiotics, and steroids, and made a rapid recovery.
This case underscores the importance of considering CVST as a rare but serious neurological complication in immunocompromised patients with severe pneumococcal meningitis.
This case report describes a man in his 40s who was taking a medication called adalimumab (which suppresses the immune system) for Crohn's disease, and who developed a severe form of bacterial meningitis caused by Streptococcus pneumoniae (pneumococcus). He rapidly deteriorated, requiring a breathing machine, and was found to have an unusual and serious complication: extensive blood clots blocking multiple large veins draining blood from the brain, a condition called cerebral venous sinus thrombosis (CVST). This research suggests that CVST is a rare but life-threatening complication that can occur alongside pneumococcal meningitis, particularly in people whose immune systems are weakened. The patient was treated with blood thinners (first heparin, then enoxaparin), a two-week course of intravenous antibiotics (ceftriaxone), and steroids. Despite the severity of his illness, he was taken off the breathing machine by day four and showed rapid improvement in his mental function and overall ability. This research suggests that prompt identification of CVST through brain imaging, followed by appropriate anticoagulation alongside standard meningitis treatment, can lead to good outcomes even in complex cases. The case highlights that doctors should maintain a high level of suspicion for rare neurological complications like CVST when treating immunocompromised patients with severe meningitis, especially if the patient's neurological condition is worse than expected or fails to improve as anticipated. Early imaging and timely intervention appear to be critical factors in achieving a favourable recovery in such situations.
Patel S, Butt M, Kang J, Gowribalan J. (2026). Pneumococcal meningitis complicated by extensive cerebral venous sinus thrombosis in an immunocompromised patient.. BMJ case reports. https://doi.org/10.1136/bcr-2025-271180