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Table 1. Clinical characteristics for the patient with Streptococcus gallolyticus meningocephalitis
Characteristics Patient data
Age (years) 80
Gender Male
Predisposing factor (s) Adenocarcinoma of colon
Bibulosity
Clinical presentation
Temperature (°C) 39.3
Neck rigidity Yes
Headache No
Score on Glasgow Coma Scale 13
Neurological deficits Delirium
CSF findings
6
Leukocyte count 74 × 10 /L
Protein level (mg/L) 6058
CSF/blood glucose ratio < 0.13
Cranial CT (MRI) Normal
Cultures
Blood culture Negative
CSF culture Positive
S. gallolyticus-associated disease
Endocarditis No
Colon adenocarcinoma Yes
Strongyloidiasis Unknown
Empirical treatment
Antibiotics Meropenem, linezolid
Dexamethasone No
Outcome Recovery
CSF: cerebrospinal fluid; CT: computed tomography; MRI: magnetic resonance imaging

CASE REPORT
An 80-year-old man was admitted to the emergency room of Guangdong Provincial Hospital of Chinese
Medicine. He presented symptoms with deliration and neck rigidity. According to his wife’s statement,
the patient complained the abdominal pain 5 days ago. Meanwhile, he had a history of radical operation
for adenocarcinoma of stomach and colon, as well as the percutaneous coronary intervention. Further
questioning for his wife and daughter revealed that the patient has the habit of drink Chinese liquor for
about 50 mL every day for decades before the partial resection of stomach. Even in the latest years, he still
drank about 20 mL every day. The features of the patient are summarized in Table 1.

On examination, he was delirious with neck rigidity, but no febrile. There was no other neurological
abnormalities. Meanwhile, there is no abdominal pain. Peripheral blood samples, including cultures, were
taken and treatment with ceftriaxone (2 g intravenous drip, ivd q12h) as well as acyclovir (75 mg peros, po
bid) were started immediately. Urgent brain computed tomography (CT) scanning was normal. Then the
lumbar puncture was performed. Laboratory studies of CSF disclosed the following values: the CSF pressure,
130 cmH O; WBCs, 15 × 10 /L; glucose < 1.11 mmol/L (serum glucose: 8.96 mmol/L); and protein, 4946 mg/L.
6
2
He was diagnosed with central nervous system (CNS) infection and was transferred to the neurological
department.
Day 1 physical examination showed a poor-nourished man in a mild altered consciousness. His vitals were:
o
temperature 36.4 C, blood pressure 145/59 mmHg, pulse rate 66 and respiration rate 20. Neurological
examination revealed a delirious man who had decreased range of motion of his neck. No other
abnormalities of neurologic system as well as the respiratory and digestive system were detected. Then, blood
routine, high-sensitivity C-reactive protein (hs-CRP), procalcitonin including cultures were taken again.
Magnetic resonance imaging (MRI), electroencephalogram (EEG) monitoring was performed. Combining