Objective:

NA

Background:

Capnocytophaga canimorsus is a gram-negative bacteria found in the mouths of humans and animals which can present as meningitis and sepsis in immunocompromised or high-risk occupational hosts. We present a case of Capnocytophaga canimorsus meningitis presenting as acute right MCA stroke.

Design/Methods:

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Results:

A 72-year-old small animal veterinarian presented from work to the emergency department (ED) with altered mental status, aphasia, left facial droop and left hemiparesis, NIHSS of 15. CT Head was negative for dense MCA sign, hemorrhage or large completed stroke and she received IV tPA.  In the ED she spiked a fever of 101.1°F and her mental status deteriorated. A routine EEG performed was negative for seizure.  A repeat CT head showed a new change of increased cerebrospinal fluid (CSF) density throughout the cerebral convexity. MRI brain confirmed the presence of proteinaceous/cellular fluid and identified 2 punctate right parietal infarcts. Broad spectrum antibiotics for meningitis coverage were started as the lumbar puncture was delayed for 24h due to IV tPA administration.  Results of the lumbar puncture were WBC 2,241/uL (90% neutrophils), RBC 424/uL, protein 274 mg/dL, glucose 71 mg/dL. CSF meningitis/encephalitis panel and cultures were negative. However, blood cultures grew Capnocytophaga canimorsus in anaerobic bottles. She was treated with Meropenem for 3 weeks. The patient improved and was discharged to inpatient rehabilitation and is now back to work with mild residual deficits of imbalance and hearing loss.  

Conclusions:

Capnocytophaga canimorsus meningitis was first described in 1976 and there are few cases reported in the literature. Our case emphasizes the importance of a broad differential for patients presenting with acute stroke symptoms and early treatment for suspected meningitis.