A 26-year-old male presented to the emergency department (ED) with a history of headache and fever since the past 1 day, and altered sensorium for the past 6 h. His past medical history revealed a history of sinusitis. On physical examination, the patient was confused, with a stiff neck, but no focal neurological deficits. His vitals revealed a heart rate of 102 beats/min, blood pressure 106/64 mmHg, respiratory rate 26/min, SpO2 99%, and temperature 38.8 °C. On arrival in the ED, the patient was resuscitated with iv fluids, antipyretics were administered for temperature control, and blood samples were sent for routine laboratory investigations, along with blood cultures. A shot of dexamethasone 10 mg iv was administered, and parenteral antibiotics—Inj Ceftriaxone 2 g iv and Inj Vancomycin 1 g iv were begun prophylactically. The patient was shifted to the ICU for close neuromonitoring. A diagnostic lumbar puncture was performed, which revealed a cell count of 5600 cells/cu mm with 98% neutrophils, glucose 20 mg/dL, and proteins 1244. The gram’s stain showed gram positive cocci, and the CSF PCR revealed Streptococcus pneumoniae. Ceftriaxone 2 g iv BD/Vancomycin 1 g iv BD were continued, along with dexamethasone 10 mg iv QID. The patient improved neurologically over the next 2 days, and was shifted to the ward. The CSF culture & sensitivity also revealed Streptococcus pneumoniae, which was sensitive to both ceftriaxone and vancomycin. Steroids were administered for 3 days and then stopped. Antibiotics were continued for 14 days, and the patient was discharged with no residual deficits.
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