Successfully treated case of meningitis caused by Elizabethkingia anophelis in an adult with fluoroquinolone-based treatment: A case report and literature review

Abstract

Elizabethkingia anophelis, a Gram-negative bacillus, is a rare cause of adult meningitis with high mortality. Due to its resistance to most β-lactams including carbapenems and aminoglycosides, the standard treatment for meningitis remains undetermined. Herein, we report the first case of adult meningitis caused by E. anophelis after nasal endoscopic transnasal surgery. In our patient, E. anophelis colonized the respiratory tract without clinical evidence of pneumonia. Although an apparent cerebrospinal fluid leak was not identified, we believe that a minor leak following brain surgery was the entry site for E. anophelis. Levofloxacin resulted in rapid resolution of fever and headache. All previously reported cases of meningitis in adults treated with fluoroquinolones survived. We highlighted the importance of prompt identification of the strain and considering changing antimicrobial agents as necessary. Although regional susceptibility rates must be carefully considered, fluoroquinolones can be a viable treatment option for adult meningitis caused by fluoroquinolone-susceptible E. anophelis.