Computed tomography (CT) of the head without contrast was unremarkable for midline shift, mass lesion, or intracranial hemorrhage. Chest radiograph showed opacities in the left lung base possibly consistent with developing pneumonia. Carcinoembryonic antigen (CEA) for liver neoplasm was marginally elevated at 3.5 ng/dL. A targeted biopsy of the liver lesion showed acute inflammation and abscess tissue with negative acid-fast bacilli (AFB) and periodic acid-Schiff (PAS) stains for microorganisms. Results showed cholelithiasis without evidence of acute cholecystitis and hepatic steatosis with a complex 6 cm cystic/solid lesion within the right hepatic lobe. Due to liver enzyme abnormality, an abdominal ultrasound was ordered. His hepatic function panel demonstrated elevated albumin of 4.9 g/dL, total bilirubin of 1.2 μmol/L, alkaline phosphatase of 174 U/L, and aspartate and alanine transaminases of 46 U/L and 91 U/L, respectively. Chemistry studies showed a sodium of 132 mmol/L. Severe acute respiratory syndrome coronavirus 2, human immunodeficiency virus (HIV), and immunologic studies were negative (Table 2). The complete blood count showed an elevated white blood cell count of 20,800 k/µL with neutrophilia and platelets of 371 × 10 3 μ/L. Laboratory analysis was performed upon admission (Table 1). Over the course of his hospital stay, however, he developed right hemiparesis. Neurological examination revealed the patient was oriented to person, place, and time his cranial nerves were grossly intact and there was no nuchal rigidity. Although he appeared weak while ambulating, he had good symmetric strength bilaterally and there were no focal deficits. The abdomen was soft, non-tender to palpation, and without masses. His heart was at a regular rate and rhythm and his lungs were clear to auscultation. On general examination, he appeared hemodynamically stable and in no acute distress. The remainder of his vital signs were as follows: blood pressure of 158/82 mmHg, heart rate of 70 beats/minute, respiratory rate of 17 breaths/minute, and pulse oximetry of 99% on room air. Upon presentation to the emergency department, he was afebrile. He worked as a gardener and reported no recent distant travel. He smoked four to five tobacco cigarettes daily and denied alcohol, drug use, or high-risk sexual behavior. The patient denied any prior history of similar symptoms, weight loss, sore throat, shortness of breath, cough, chest pain, or abdominal pain. Three days prior to presentation, he had vomiting and three to four episodes of non-sanguineous diarrhea which had resolved. He reported a fever and frontal headache partially relieved by acetaminophen. Case PresentationĪ 37-year-old male with no relevant medical history presented to the emergency department with a one-week history of generalized weakness. coli in an adult with multiple brain lesions and liver abscess successfully treated with antibiotics. Here, we report a case of bacterial meningitis caused by E. Bacterial meningitis is a medical emergency, and empiric antibiotics should be initiated within one hour of arrival to the emergency department prior to obtaining the results of the CSF gram stain and culture. In the case of bacterial meningitis, typical CSF findings include polymorphonuclear leukocytosis, decreased glucose concentration, and increased protein concentration and opening pressure. ĭiagnosis of bacterial meningitis is made via examination of cerebrospinal fluid (CSF). Although most patients with meningitis present with the classic clinical triad of fever, headache, and nuchal rigidity, others may have signs of altered mental status ranging from lethargy to coma. Regardless of the pathogen, bacterial meningitis can progress rapidly within a few hours to several days depending on the organism. coli meningitis is uncommon, and typically only seen after neurosurgery, trauma, or hepatic cirrhosis. However, after the first month of life, E. coli is one of the leading causes of neonatal meningitis in the United States, second only to group B Streptococcus.
In adults, extraintestinal infections typically occur in the setting of translocation, with the urinary tract being the most common site of infection. Escherichia coli is a gram-negative rod found in the gastrointestinal tract as part of the normal flora and is typically nonpathogenic.