Outcome and Follow-up
Altogether, our findings suggested thatS. suis infected the patient through the scars in his hands, causing meningitis, ventriculitis, and inner ear dysfunction. The antibiotic treatment was changed from ceftriaxone, vancomycin, and ampicillin to penicillin G (150,000 units/kg/day in 4-h intervals) according to antimicrobial susceptibility results (Table 2).
Despite dexamethasone treatment for 4 days, the patient had a persistent hearing impairment. Hearing tests revealed a decrease of 110 dB on the right and left sides. Auditory brainstem response assessment showed a value of 100 dB without a bilateral response. On day 6, contrast MRI showed right cochlea enhancement, suggesting right labyrinthitis. We concluded that the patient had sensorineural hearing loss owing to inner ear damage. Therefore, corticosteroid therapy was administered. Intravenous methylprednisolone (250 mg/day) was initiated; the dose was tapered to 125 mg/day on day 8, 60 mg/day on day 10, and 40 mg/day on day 12.
On day 6, the patient’s general condition improved, and CSF examination revealed improved pressure (16 cm CSF). Laboratory values also improved as follows: cell count, 44 cells/µL, protein level, 84 mg/dL, and plasma glucose level, 180 mg/dL. On day 20, MRI showed improvement in ventriculitis, and penicillin G was administered for 22 days. After treatment completion, the patient showed no signs of recurrent meningitis and was discharged on day 40. Inner ear dysfunction did not improve, and cochlear implant surgery was performed 4 months after disease onset. The patient gradually improved and recovered without relapse.