Abstract
Streptococcus pneumoniae - S. pneumoniae, Emergency Department - ED, Diabetes Mellitus - DM, Complete Blood Count - CBC, Comprehensive Metabolic Panel - CMP, Hepatitis C Virus - HCV, Cerebrospinal fluid - CSF, Blood Urea Nitrogen - BUN, White Blood Cell - WBC, Red Blood Cell - RBC INDEX TERMS: The patient was experiencing persistent mastoid pain and his neck was resistant to movement. Because the patient demonstrated signs of meningitis, he was started on broad-spectrum antimicrobials and an antiviral medication. Upon receiving the laboratory results and sensitivities, the meningitis was treated with a combination of vancomycin, moxifloxacin and rifampin for about two weeks while the patient was hospitalized. Since the bacteria had such high MICs to penicillin and ceftriaxone, the synergistic action of all three drugs chosen was standard therapy for treatment resistant pneumococcal meningitis. In a four-year study of 682 patients presenting with bacterial meningitis, 69% were hyperglycemic and 25% severely hyperglycemic with 12% of the patients being diabetic.1 S. pneumoniae accounted for 67% of the cases of meningitis in diabetics and 33% of diabetics had an infection focus of otitis/sinusitis.1 The infection acts as an inciting stressor stimulating release of hormones such as cortisol, glucagon and catecholamines that act to increase blood glucose while down-regulating insulin.