Abstract
Objective Central nervous system (CNS) demyelination has been associated with viral infections. However, there is no known association with acute, bacterial infections. This report describes a patient with typical CNS demyelination associated with meningitis due to Neisseria meningitidis.
Method and Result A 20-years old Hispanic female presented with headaches, vomiting and fever in March 2021. A brain MRI revealed nine T2 periventricular and juxtacortical demyelinating lesions. Two lesions exhibited diffusion restriction indicating acuity. The CSF protein was 3.36 g/L, glucose was 1.4 mmol/L, with 1695 polymorphs per ul and no oligoclonal bands. Neisseria meningitidis was cultured from the CSF. She was treated with dexamethasone and ceftriaxone with complete recovery and without neurological sequalae. A follow up brain MRI performed six months later showed resolution of the lesions with no further clinical or radiological developments.
Conclusion CNS demyelination in the context of bacterial meningitis has not been described before. Given that N meningitidis is extracellular, induction of oligodendrocyte cell death by endotoxins, or molecular mimicry to bacterial porins with complement activation are plausible pathomechanisms. In this case, the inciting demyelinating agent evidently disappeared with the pathogen perhaps providing a clue as to what promotes relapsing demyelination.
