Meningitis due to Fusobacterium necrophorum in an adult

We report a fatal case of meningitis, caused by Fusobacterium necrophorum, secondary to otitis media in an alcoholic male. Diagnosis was delayed due to the typical slow growth of the organism. The clinical course was complicated by encephalitis and by hydrocephalus. The patient failed to respond to metronidazole and penicillin. The patient died on day 12 from increased intracranial pressure and brain stem infarction.This case emphasizes the need for a high index of clinical suspicion to make the diagnosis of Fusobacterium necrophorum meningitis. We recommend the use of appropriate anaerobic culture techniques and antimicrobial coverage for anaerobic organisms when the gram stain shows gram negative bacilli.Fusobacterium necrophorum may cause a number of clinical syndromes, collectively known as necrobacillosis. Meningitis is a significant cause of mortality, rarely reported in the adult population. Diagnosis is often delayed by difficulties encountered in isolating the organism. Here, we report a fatal case of meningitis from complicated otitis media caused by this organism.A 51 year male was brought to the emergency department (ED) by his family for confusion and shaking episodes. The patient was very lethargic in the ED and was intubated for airway protection. Family reported that he had not been well for several months, but the family was not able to define any specific symptoms until the past few days when he reported right ear pain. The patient had been given a prescription for erythromycin within the previous week for a diagnosis of otitis media; the patient had not taken any doses for at least two days. The only significant past medical history was of ongoing alcohol abuse without intravenous drug use. The family reported that he had no alcohol intake over the two days prior to presentation. Vitals on presentation: temperature 98.5°F (36.9°C), heart rate 125/min, respirations 25/min, blood pressure 219/121, Oxygen saturation 96 % on room air. On physical exam