https://doi.org/10.4081/ecj.2025.13700
From bacterial pyelonephritis to meningitis: a case report and literature review
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Published: 28 April 2025
Urinary Tract Infections (UTIs) are among the most common infections in individuals with Diabetes Mellitus (DM) and can progress to severe complications. This case report presents a 38- year-old male with poorly controlled DM who developed Escherichia coli pyelonephritis complicated by bacteremia and subsequent bacterial meningitis. Despite initial antibiotic therapy for a complicated UTI, the patient developed neurological symptoms, including confusion, drowsiness, and clinically evident nuchal rigidity. Laboratory findings supported bacterial meningitis, though Cerebrospinal Fluid (CSF) cultures remained sterile, likely due to prior antibiotic administration. Blood and urine cultures confirmed E. coli as the causative pathogen. Management included broad-spectrum antibiotics, corticosteroids, insulin, and the placement of a double-J stent. The patient gradually improved and was discharged after two weeks with full recovery. This case underscores the rare but life-threatening progression of pyelonephritis to meningitis in diabetic patients. Clinicians should maintain a high index of suspicion for systemic infections in diabetics presenting with UTIs and neurological symptoms, as early diagnosis and aggressive management are critical for reducing morbidity and mortality.
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