Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA.
BMC Infect Dis. 2011 May 19;11:136. doi: 10.1186/1471-2334-11-136.
Persistent neutrophilic meningitis is an unusual form of chronic meningitis that is defined as clinical meningitis with a neutrophilic pleocytosis that persists for greater than 7 days despite empiric antimicrobial therapy. Although numerous disease processes can cause this syndrome, the majority of cases are due to opportunistic pathogens infecting immunocompromised hosts.
A 47 year-old female presented after basilar skull fracture with persistent neutrophilic meningitis unresponsive to empiric broad-spectrum antibiotics. After more than weeks of intensive therapy, 4 hospitalizations and 3 relapses, Nocardia cyriacigeorgica was identified from cerebral spinal fluid. Induction therapy was begun with Ceftriaxone and trimethoprim-sulfamethoxazole (TMP-SMX) for 6 weeks followed by therapy with TMP-SMX and doxycycline for one year. The patient made a complete recovery without sequelae.
Due to the difficulty in obtaining a microbiologic diagnosis, appropriate treatment in cases of persistent neutrophilic meningitis is often delayed leading to morbidity, This case highlights a number of the unique features of Nocardia meningitis and the importance of considering Nocardia infection as a cause of persistent neutrophilic meningitis even in immunocompetent patients.
持续性中性粒细胞性脑膜炎是一种不常见的慢性脑膜炎形式，其定义为临床脑膜炎，伴有中性粒细胞增多症，尽管经验性抗菌治疗，但持续时间超过 7 天。尽管许多疾病过程都可能导致这种综合征，但大多数病例是由于机会性病原体感染免疫功能低下的宿主。
一名 47 岁女性因颅底骨折后出现持续性中性粒细胞性脑膜炎，对经验性广谱抗生素治疗无反应。经过数周的强化治疗、4 次住院和 3 次复发后，从脑脊液中鉴定出触须形诺卡氏菌。诱导治疗采用头孢曲松和复方磺胺甲噁唑（TMP-SMX）6 周，然后用 TMP-SMX 和多西环素治疗 1 年。患者完全康复，无后遗症。
由于微生物学诊断困难，持续性中性粒细胞性脑膜炎的治疗往往会延迟，导致发病率增加。本病例强调了触须形诺卡氏菌脑膜炎的一些独特特征，以及即使在免疫功能正常的患者中，也应考虑诺卡氏菌感染作为持续性中性粒细胞性脑膜炎的病因的重要性。
