Recurrent Streptococcus pneumoniae meningoencephalitis in a patient with a transethmoidal meningoencephalocele

We report a case of recurrent Streptococcus pneumoniae meningoencephalitis with a transethmoidal meningoen-cephalocele (TEME) but without cerebrospinal fluid (CSF) leakage. A 35-year-old man was admitted with S. pneumoniae meningitis. He had suffered from four episodes of recurrent pneumococcal meningitis during the previous 4 years. A computed tomography scan of the paranasal sinus showed the TEME protruding through a bony defect of the right frontal base. However, the patient did not have symptoms that could be attributable to CSF leakage, and radioisotope cisternography did not identify a leak. Brain magnetic resonance imaging revealed cortical lesions overlying the TEME, and electroencephalography revealed epileptiform discharges in frontal regions. Appropriate antibiotics therapy without steroids was given to improve his condition. The presented case suggests that even in the absence of clinically demonstrable CSF leakage, an occult skull-base defect and its associated meningoencephalocele should be considered in patients with recurrent bacterial meningitis.