Viridans streptococcal meningitis following penetrating cervical injury

Viridans streptococcal meningitis is a rare occurrence, usually as a result of iatrogenic invasion of the dural space or significant immunosuppression. We report a case of an otherwise healthy child who had Streptococcus salivarius meningitis as a result of lacerations to the posterior neck after a fall onto a drinking glass. Despite being well appearing on initial presentation, our patient had pneumocephalus on head computed tomography that was not initially recognized. He was discharged from the emergency department and subsequently returned within 24 hours with meningismus. This case highlights the increased risk of meningitis in patients with cerebrospinal fluid leak and the importance of radiographic signs that suggest a traumatic fistula may have occurred. To our knowledge, this is the first case of viridians streptococcal meningitis after penetrating trauma to the neck.