Adult Pneumococcal Meningitis with No Inflammatory Cells in the CSF

An 18 year old male patient was admitted to the Medical Intensive Care Unit of the Tikur Anbessa Hospital in October 1988. He was in deep coma and had findings consistent with a left lobar pneumonia. Lumbar puncture revealed a turbid CSF. Gram stain on both centrifuged and uncentrifuged specimens revealed plenty of gram positive diplococci with no single inflammatory cell. CSF culture proved the organism to be Streptococcus pneumoniae. The patient was put on combination of high doses of intravenous sodium-penicillin and chloramphenicol with all appropriate supportive management. However, the patient died only after three hours of stay in the hospital. The condition of diminished to absent inflammatory response in the CSF associated with pneumococcal meningitis in adults is discussed with a review of the literature.