Hemorrhagic Transformation in Pneumococcal Meningitis: A Rare but Devastating Complication

Authors

  • A A Md Ryhan Uddin Sr Consultant & Coordinator; Department of Medical ICU; Evercare Hospital Chattogram; Bangladesh
  • Somen Chowdhury Consultant; Department of Neurology; Evercare Hospital Chattogram; Bangladesh
  • Tarek Bin Kashem Registrar, Department of Medical ICU, Evercare Hospital Chattogram; Bangladesh
  • Swarup Das Clinical Associate; Department of Medical ICU; Evercare Hospital Chattogram; Bangladesh
  • Sheikh Ul Alam Specialist; Department of Medical ICU; Evercare Hospital Chattogram; Bangladesh
  • Razaul Karim Sr Consultant; Department of Medical ICU; Evercare Hospital Chattogram; Bangladesh
  • Joheb Hasan Registrar; Department of Medical ICU; Evercare Hospital Chattogram; Bangladesh.
  • Rajesh Barua Clinical Associate; Department of Medical ICU; Evercare Hospital Chattogram; Bangladesh.
  • Saima Jabin Clinical Associate; Department of Medical ICU; Evercare Hospital Chattogram; Bangladesh
  • Eshraque Hossain SMO; Department of Medical ICU; Evercare Hospital Chattogram; Bangladesh.
  • Vaskar Dutta SMO; Department of Medical ICU; Evercare Hospital Chattogram; Bangladesh.
  • Shantanu Mohajan Registrar; Department of Medical ICU; Evercare Hospital Chattogram; Bangladesh.
  • Abrar Jahin Trainee Doctor; Department of Internal Medicine; Chittagong International Medical College & Hospital, Chattogram, Bangladesh

DOI:

https://doi.org/10.3329/bccj.v13i2.84409

Keywords:

Cerebral Vasculitis, Hemorrhagic Transformation, Intracranial Hemorrhage, Neuroimaging, Neurocritical Care Pneumococcal Meningitis, Sepsis

Abstract

Bacterial meningitis is a neurological emergency with significant morbidity and mortality. Streptococcus pneumoniae is the leading cause in adults, with complications such as cerebral infarction, hydrocephalus, and seizures. Haemorrhagic transformation is extremely rare, reported in 2–9% of cases, but is associated with poor prognosis. We report a case of pneumococcal meningitis complicated by extensive frontal lobe and cerebellar haemorrhages. The patient presented with classic meningitis symptoms and rapidly developed a generalized tonic–clonic seizure. Neuroimaging revealed multiple haemorrhages without vascular malformations, hypertension, anticoagulant exposure, or coagulopathy. Venous sinus thrombosis was excluded. Systemic sepsis and vasculitis were considered the likely contributors to haemorrhagic transformation. Despite the severity, the patient showed significant neurological recovery following targeted antibiotics, intensive care, and multidisciplinary rehabilitation. This case emphasizes the need for early neuroimaging in meningitis patients with neurological decline, even in the absence of vascular risk factors, to enable timely recognition and intervention.

Bangladesh Crit Care J September 2025; 13 (2): 120-123

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Published

2025-10-16

How to Cite

Uddin, A. A. M. R., Chowdhury, S., Kashem, T. B., Das, S., Alam, S. U., Karim, R., … Jahin, A. (2025). Hemorrhagic Transformation in Pneumococcal Meningitis: A Rare but Devastating Complication. Bangladesh Critical Care Journal, 13(2), 120–123. https://doi.org/10.3329/bccj.v13i2.84409

Issue

Vol. 13 No. 2 (2025)

Section

Case Reports

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