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Description
Pneumococcal meningitis is the most common cause of bacterial meningitis in children, with the highest incidence in those under five years of age. Although pneumococcal conjugate vaccines have reduced invasive disease, infections continue to occur among fully vaccinated individuals. Streptococcus pneumoniae is an encapsulated gram-positive coccus that evades host immunity and can cause severe central nervous system infection following bloodstream invasion and traversal of the blood-brain barrier. Risk assessment often emphasizes vaccination status and immunodeficiency, with less attention given to structural predisposing factors. Cerebrospinal fluid leaks are an underrecognized cause of breakthrough pneumococcal meningitis and may be clinically occult, increasing the risk of recurrence. We report a case of pneumococcal meningitis in a fully vaccinated adolescent with an occult CSF leak.
An otherwise healthy, fully vaccinated 14-year-old male presented to an outside hospital with one day of headache, confusion, altered mental status, recurrent vomiting, and fever. He was transferred to Pediatric ICU at Helen DeVos Children's Hospital for further management of suspected meningitis. A lumbar puncture showed low glucose, elevated protein and significant pleocytosis consistent with bacterial meningitis. A peripheral blood culture and PCR meningitis/encephalitis panel was positive for Streptococcus pneumoniae. CT Brain showing cerebral edema and meningitic inflammation. An immunodeficiency evaluation was unremarkable.
Pneumococcal meningitis may occur in fully vaccinated, previously healthy adolescents in the presence of predisposing anatomical abnormalities. Cerebrospinal fluid leaks are an important and frequently underrecognized risk factor for invasive pneumococcal disease, even in the absence of facial trauma or immunocompromising conditions. Breakthrough bacterial meningitis should prompt evaluation for structural defects, including CSF leak. Early diagnosis and definitive management may reduce the risk of recurrent invasive infection.
Publication Date
5-8-2026
Disciplines
Pediatrics
Recommended Citation
Patel K, Campbell H, Metz M. Not just bad luck: Pneumococcal meningitis in a vaccinated adolescent leading to the diagnosis of a CSF leak. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.
Comments
2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2007