Pneumocephalus Associated with Aggressive Pneumococcal Meningitis

A 44-year-old woman presented with headache and delirium. Brain tomography indicated pneumocephalus, while blood and cerebrospinal fluid cultures revealed Streptococcus pneumoniae. Despite antibiotic treatment and admission to the intensive care unit, the patient died 3 days later. Pneumocephalus in association with meningitis is very rare and may be caused by gas produced by microorganisms. LEARNING POINTS: Non-traumatic pneumocephalus should raise the suspicion of meningitis and prompt suitable treatment. Previous pneumococcal saccharide conjugate vaccine administration does not exclude the possibility of serious pneumococcal infection.