Multidrug-Resistant Proteus Mirabilis Meningitis in an Adolescent with Homozygous Sickle Cell Disease: Case Report

Background: Sickle cell disease (SCD) increases susceptibility to severe bacterial infections due to early functional asplenia. Bacterial meningitis in this population is usually caused by encapsulated organisms, while Proteus mirabilis meningitis is rare. Multidrug resistance further complicates management. Case presentation: A 17-year-old girl with homozygous SCD (HbSS), receiving hydroxyurea and folic acid therapy with up-to-date immunizations, was admitted to the intensive care unit with fever, altered consciousness, dysarthria, and paraparesis in the context of a vaso-oclusive crisis. An initial cerebral CT scan without contrast was normal. Despite empirical ceftriaxone therapy, she developed meningeal signs. Cerebrospinal fluid was turbid with neutrophilic pleocytosis, hypoglycorrhachia, and elevated protein. Culture identified a metopene—susceptible, multidrug-resistant strain of Proteus mirabilis. Targeted intravenous metopen (2 g every 8 hours) and supportive care for sickle cell disease, including red blood cell transfusion, led to defervescence and complete neurological recovery in less than 48 hours. Conclusions: This rare case underlines the need for early lumbar puncture and rapid microbiological confirmation in severe infections in patients with SCD, particularly in settings where antimicrobial resistance is increasing.