Streptococcus Oralis meningitis from right sphenoid Meningoencephalocele and cerebrospinal fluid leak

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p><jats:italic>Streptococcus oralis</jats:italic> belongs to the <jats:italic>Streptococcus mitis</jats:italic> group and is part of the normal flora of the nasal and oropharynx (Koneman et al., The Gram-positive cocci part II: streptococci, enterococci and the ‘Streptococcus-like’ bacteria. Color atlas and textbook of diagnostic microbiology, 1997). <jats:italic>Streptococcus oralis</jats:italic> is implicated in meningitis in patients with decreased immune function or from surgical manipulation of the central nervous system. We report a unique case of meningitis by S<jats:italic>treptococcus oralis</jats:italic> in a 58-year-old patient with cerebral spinal fluid leak due to right sphenoid meningoencephalocele.</jats:p> </jats:sec> <jats:sec> <jats:title>Case presentation</jats:title> <jats:p>A 58-year-old female presented in the emergency department due to altered mental status, fevers, and nuchal rigidity. Blood cultures were positive for S<jats:italic>treptococcus oralis</jats:italic>. Magnetic resonance stereotactic imaging of head with intravenous gadolinium showed debris in lateral ventricle occipital horn and dural thickening/enhancement consistent with meningitis. There was also a right sphenoidal roof defect, and meningoencephalocele with cerebrospinal fluid leak as a result. The patient was treated with ceftriaxone and had endoscopic endonasal repair of defect. She had complete neurologic recovery 3 months later.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Cerebrospinal fluid leak puts patients at increased risk for meningitis. Our case is unique in highlighting S<jats:italic>treptococcus oralis</jats:italic> as the organism implicated in meningitis due to cerebrospinal fluid leak.</jats:p> </jats:sec>