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Case report
Rampant spread of infection in an afebrile immune-competent patient presenting with young-onset ischaemic stroke
  1. Umang Arora1,
  2. Animesh Ray1,
  3. Surabhi Vyas2 and
  4. Naval Kishore Vikram1
  1. 1Medicine, All India Institute of Medical Sciences, New Delhi, India
  2. 2Radiology, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Animesh Ray; doctoranimeshray{at}


A 27-year-old healthy woman developed spontaneous right-sided orbital cellulitis, followed by left hemiparesis and cranial nerve palsies. MRI revealed underlying basal exudates and vasculitic infarction involving the pons and cerebellar peduncles, following which a cerebrospinal fluid examination confirmed acute bacterial meningitis. Although the patient remained afebrile, imaging revealed asymptomatic septic foci in bilateral lungs, empyema and pyelonephritis. Blood culture grew drug-resistant Klebsiella pneumoniae. The case highlights the absence of fever in an immune-competent patient presenting with young-onset stroke secondary to meningitis.

  • meningitis
  • neuroimaging
  • stroke
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  • Contributors UA and AR were involved in the clinical management of the patient, acquisition of clinical data, conceptualising and writing the manuscript draft. SV contributed the radiological images and their interpretation as well as editing the manuscript. NKV supervised the drafting as well as editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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