Multiple Neurological Complications and Multidrug-Resistant Bacterial Infections During Prolonged Intensive Care for Undocumented Meningoencephalitis in Côte d'Ivoire: A Case Report.

Acute meningoencephalitis requiring intensive care may be complicated by severe neurological injury and nosocomial infections. Hydrocephalus is well recognized, whereas spinal cord ischemia, central diabetes insipidus, and flaccid tetraparesis are rarely reported. Their coexistence, together with successive infections involving multidrug-resistant organisms, presents substantial diagnostic and therapeutic challenges. A previously healthy 32-year-old man presented with neck and back pain following a road traffic accident, subsequently developing cerebellar signs, acute confusion, and meningeal signs without fever. Cerebrospinal fluid (CSF) analysis revealed neutrophilic pleocytosis, elevated protein, and marked hypoglycorrhachia. Microbiological investigations were negative, and no causative pathogen was identified. Empirical antimicrobial therapy was followed by normalization of the CSF leukocyte count by hospital day 6. Despite this initial response, the patient required mechanical ventilation and developed shunt-dependent tetraventricular hydrocephalus, probable central diabetes insipidus, imaging findings suggestive of thoracic spinal cord ischemia, and areflexic flaccid tetraparesis with diffuse axonal sensorimotor neuropathy. His prolonged intensive care course was further complicated by successive nosocomial infections involving multidrug-resistant bacteria. He died on hospital day 70 from septic shock associated with Enterobacter cloacae bacteremia and multiorgan failure. Negative microbiological findings do not exclude meningoencephalitis when clinical and CSF abnormalities support the diagnosis, although alternative etiologies require consideration. Improvement in CSF findings does not preclude subsequent neurological deterioration or nosocomial infection. Continued neurological assessment, rigorous infection-prevention measures, and prompt investigation of suspected nosocomial infections remain essential throughout prolonged intensive care, particularly in resource-limited settings.