Abstract Introduction Streptococcus vestibularis is a harmless oral bacterium that rarely causes infections, let alone central nervous system disease. Even more unusual is the occurrence of meningitis from a sphenoid sinus cerebrospinal fluid leak, which often goes unnoticed because patients don’t have the classic symptom of clear nasal drainage. Case Presentation In this case, a 63-year-old man with asthma, obstructive sleep apnea, hypertension, and hyperlipidemia arrived at the hospital with nausea, vomiting, bloody diarrhea, and mild chest discomfort after attending a music festival. Within hours, his condition deteriorated: he became increasingly agitated and confused and ultimately required intubation to protect his airway. He spiked a fever of 104.1 °F, and imaging revealed a small defect in the posterior sphenoid wall suggestive of a CSF leak. A lumbar puncture confirmed purulent meningitis, and cultures grew S. vestibularis. He received broad-spectrum antibiotics, later narrowed to ceftriaxone, and gradually improved. ENT and neurosurgery determined that surgical repair of the CSF leak would be deferred until the infection cleared. Discussion This case highlights that even seemingly benign oral flora can cause life-threatening illness when anatomic defects provide direct CNS access. This abstract is funded by: None
Lone et al. (Fri,) studied this question.