Spontaneous Gram-negative Bacterial Meningitis Following Steroid Therapy for Severe COVID-19

Abstract

Abstract This case demonstrates an unusual case of spontaneous Gram-negative bacillary meningitis (GNBM) due to Serratia following COVID-19 and steroid exposure. A 52-year-old male presented with clinical features of acute meningitis following a prolonged hospitalization for severe COVID-19 pneumonia, during which he was administered corticosteroids. Neuroimaging was normal. Cerebrospinal fluid (CSF) analysis revealed high protein, hypoglycorrhachia, and neutrophilic pleocytosis. The Gram stain showed plenty of neutrophils but no bacteria. CSF culture demonstrated convex 1–2 mm colonies, slightly umbonate with entire margins, and opaque. On VITEK2, this was identified as Serratia marcescens and was susceptible to all tested antibiotics. Clinical improvement was noted after 48 h with the administration of meropenem (2 g q8 h) and levofloxacin (750 mg once daily). After a week of treatment, repeat CSF analysis showed a decrease in the CSF protein and total white blood cells, lymphocytic pleocytosis, and an increase in the CSF glucose. The patient made a complete recovery following 3 weeks of antibiotic therapy. This case report highlights that steroids should be used cautiously and judiciously in the COVID-19 setting. Serratia is a rare cause of spontaneous GNBM.