A Pseudo-Outbreak of Echinocandin-Resistant Candida Glabrata: the Unreliability of Caspofungin Testing in Predicting Echinocandin Susceptibility

BACKGROUND: Group B streptococcal (GBS) meningitis is uncommon in non-puerperal adults outside of significant immunocompromise or structural abnormalities. CASE PRESENTATION: We describe a relatively healthy 62-year-old man with GBS bacteremia, abnormal lumbar puncture, and MRI-confirmed leptomeningitis, ventriculitis, right cerebellitis, and cerebritis who presented without overt symptoms of meningitis. DIAGNOSIS: The suspected source of infection was a high-inoculum genitourinary infection in the setting of hydronephrosis and recent cystoscopy. We performed a literature review of previous cases and clusters of GBS meningitis. DISCUSSION: With increasing recognition of invasive GBS infection among adult patients, and in light of our patient’s atypical presentation, we propose that an index of suspicion for GBS meningitis be maintained, even for patients who would traditionally have been considered at lower risk.