Targeted therapy plus dexamethasone resolves S. suis meningitis without surgery in case reportMan's S. suis Meningitis Resolved Without Surgery

Frontiers in Medicine Published August 30, 2026 DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider non-surgical management with targeted therapy and dexamethasone in select S. suis meningitis cases with hydrocephalus, but evidence is limited.

This is a single case report of a 52-year-old man with Streptococcus suis meningitis complicated by hydrocephalus. The intervention was targeted antimicrobial therapy combined with short-course adjunctive dexamethasone. The primary outcome was clinical and radiological resolution, which was achieved completely without the need for neurosurgical intervention. The patient also maintained intact bilateral hearing at the 10-month follow-up.

The case highlights the potential role of accurate hydrocephalus subtyping via contrast-enhanced MRI and rapid pathogen identification via metagenomic next-generation sequencing (mNGS) in guiding non-neurosurgical management in selected patients. The authors suggest that these diagnostic tools may inform clinical decision-making, potentially avoiding invasive procedures in carefully chosen cases.

The main limitation is that this is a single case report, so the results cannot be generalized to the broader population of patients with S. suis meningitis. No adverse events, funding sources, or conflicts of interest were reported. The certainty of the evidence is low, and the findings should be interpreted with caution.

For clinicians, this case offers a glimpse into a possible conservative approach for managing hydrocephalus in the setting of S. suis meningitis, but it does not provide sufficient evidence to change standard practice. Further research with larger case series or comparative studies would be needed to validate these observations.

How this fits prior evidence

This case report extends prior coverage on dexamethasone use in infectious and inflammatory conditions. Prior items showed prophylactic dexamethasone reduces radiation-induced pain flares and low-dose oral dexamethasone is comparable to high-dose in croup. Here, adjunctive dexamethasone was used in S. suis meningitis with hydrocephalus, suggesting a potential role in reducing inflammation, though the evidence is limited to a single case. It also contrasts with prior coverage on anti-CD38 regimens in myeloma and AL amyloidosis, as this case involves a different disease and intervention.

A case report describes a 52-year-old man who developed meningitis caused by the bacterium Streptococcus suis, which led to a complication called hydrocephalus, a buildup of fluid in the brain. He was treated with targeted antibiotics and a short course of the steroid dexamethasone. Remarkably, his infection and the hydrocephalus completely resolved without needing any neurosurgical procedure, such as a shunt. At a 10-month follow-up, his hearing, which is often affected by this type of meningitis, remained intact.

This is just one person's story, so it's not proof that this approach works for everyone. The report highlights that using advanced imaging (contrast-enhanced MRI) to accurately classify the type of hydrocephalus and rapid genetic testing (mNGS) to identify the bacteria quickly may have helped guide the decision to avoid surgery.

Because this is a single case, the results cannot be generalized to all patients with S. suis meningitis. The main takeaway is that in carefully selected patients, non-surgical management might be possible, but more research is needed. If you or a loved one faces a similar situation, it's crucial to follow the advice of your medical team, as each case is unique.

What this means for you:

In one case, S. suis meningitis with hydrocephalus resolved without surgery, but this is not proof for everyone.

Common questions

What is Streptococcus suis meningitis?

Streptococcus suis is a bacterium that can cause meningitis, an infection of the membranes around the brain and spinal cord. It is usually linked to contact with pigs or pork products. In this case, a 52-year-old man had this infection, which led to a complication called hydrocephalus.

What is hydrocephalus and how was it treated in this case?

Hydrocephalus is a buildup of fluid in the brain's cavities, which can increase pressure. Typically, it might require surgery to drain the fluid. In this case report, the patient's hydrocephalus resolved completely with just antibiotics and dexamethasone, without any neurosurgical procedure.

Did the patient have any hearing loss after treatment?

No. At the 10-month follow-up, the patient had intact bilateral hearing. Hearing loss is a common complication of bacterial meningitis, so this is a notable positive outcome, but it's from a single case and may not apply to everyone.

Study Details

Study typeGuideline

EvidenceLevel 5

PublishedAug 2026

View Original Abstract ↓

BackgroundStreptococcus suis (S. suis) meningitis is a severe zoonotic central nervous system infection, with permanent sensorineural hearing loss as its most common long-term sequela. Hydrocephalus is an extremely rare and underrecognized complication of S. suis meningitis, and no case of communicating hydrocephalus secondary to S. suis meningitis managed successfully with non-neurosurgical therapy has been formally documented.Case presentationA 52-year-old man presented with 8 days of progressive dizziness and gait imbalance. Contrast-enhanced magnetic resonance imaging (MRI) confirmed communicating hydrocephalus with diffuse leptomeningeal enhancement and no ventricular obstruction. Cerebrospinal fluid (CSF) cultures remained persistently negative, while metagenomic next-generation sequencing (mNGS) identified S. suis within 48 h with a relative abundance of 92.60%. Guideline-recommended targeted antimicrobial therapy combined with short-course adjunctive dexamethasone achieved complete clinical and radiological resolution without neurosurgical intervention. The patient remained asymptomatic with intact bilateral hearing at the 10-month follow-up.ConclusionTo our knowledge, this is the first reported case of S. suis meningitis-associated communicating hydrocephalus successfully managed without neurosurgery. Accurate hydrocephalus subtyping via contrast-enhanced MRI and rapid pathogen identification via mNGS may help inform clinical decision-making regarding the potential for non-neurosurgical management in carefully selected patients.

Targeted therapy plus dexamethasone resolves S. suis meningitis without surgery in case reportMan's S. suis Meningitis Resolved Without Surgery

How this fits prior evidence

Common questions

Study Details

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