Differential Diagnosis and Treatment
These findings led us to diagnose bacterial meningitis caused by
gram-positive bacteria. Ceftriaxone (2.0 g in 12-h intervals),
vancomycin (1.0 g in 8-h intervals), ampicillin (2.0 g in 4-h
intervals), and dexamethasone (9.9 mg in 6-h intervals) were
administered. On day 2, the fever subsided, but the patient experienced
a generalized seizure. Levetiracetam 1000 mg was administered to control
the seizure. Head diffusion-weighted magnetic resonance imaging (MRI)
showed a high signal in the bilateral lateral ventricular triangles,
indicating ventriculitis (Figure 1), and S. suis serotype 2 was
identified in CSF culture. A careful physical examination revealed two
small scars in the patient’s left hand (Figure 2). A family member
mentioned that the patient often accidentally pointed the skewer at his
hand when cooking pork on a spit.