A case of fulminant Bacillus cereus meningoencephalitis after neuroplasty with white matter change

Bacillus cereus meningitis can show unusual presentation and very rapid progression associated with high mortality and unusual MRI findings. We report a 77-year-old man with fever and altered mentality after epidural neuroplasty for chronic lumbar spinal pain. Symptoms rapidly progressed over the 12 hours following surgery. He was diagnosed with meningoencephalitis by Bacillus cereus confirmed by CSF culture and DNA sequencing. He improved with antibiotics slowly although his mental state did not completely revert to his prior level. This case demonstrates the rapid and fulminant clinical picture produced by Bacillus cereus associated with neuroplasty. It also shows peculiar frontal white matter changes with hydrocephalus on MRI.