{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:01:22Z","timestamp":1790744482151,"version":"4.1.0"},"reference-count":6,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    This case report describes a 32-year-old female patient who developed acute pneumococcal meningitis following six-year chronic orbital inflammatory changes after strabismus corrective surgery. The patient experienced gradual deterioration of right-eye vision and recurrent retro-orbital headache; serial magnetic resonance imaging (MRI) from 2021 to 2023 demonstrated diffuse intraconal retrobulbar abnormalities and extraocular-muscle thickening. She subsequently presented with high fever, generalized seizures and impaired consciousness. Cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) detected\n                    <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                    and low-abundance\n                    <jats:italic>Epstein\u2013Barr virus<\/jats:italic>\n                    (EBV) DNA; Active EBV-associated central nervous system infection could not be confirmed in the absence of CSF quantitative EBV polymerase chain reaction (PCR), EBV serology and immune-status testing. The patient received broad-spectrum intravenous antimicrobial, antiviral and glucocorticoid therapy, followed by endoscopic endonasal resection of inflammatory lesions at the ethmoid-skull-base complex. Histopathological examination of surgical specimens revealed non-specific inflammatory granulation tissue, and Langerhans cell histiocytosis was excluded. At six-month follow-up, the patient remained seizure-free; infectious foci showed near-complete resolution on imaging, yet mild residual orbital-leptomeningeal abnormalities persisted with modest visual improvement. This case demonstrates the potential for delayed intracranial extension from long-standing chronic orbital inflammation and highlights both the diagnostic utility and interpretive limitations of CSF-mNGS in clinical practice.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1918613","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:48:31Z","timestamp":1790743711000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pneumococcal meningitis secondary to chronic orbital inflammation with skull base erosion: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Xinghua","family":"Tie","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Second Hospital & Clinical Medical School, Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoman","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Second Hospital & Clinical Medical School, Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1684\/epd.2022.1491","article-title":"Common infectious and parasitic diseases as a cause of seizures: geographic distribution and contribution to the burden of epilepsy","volume":"24","author":"Yacubian","year":"2022","journal-title":"Epileptic Disord"},{"key":"B2","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1111\/j.1528-1167.2008.01750.x","article-title":"Bacterial meningitis and epilepsy","volume":"49","author":"Murthy","year":"2008","journal-title":"Epilepsia"},{"key":"B3","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/s40478-016-0297-4","article-title":"Pneumococcal meningitis: clinical-pathological correlations","volume":"4","author":"Engelen-Lee","year":"2016","journal-title":"Acta Neuropathol Commun"},{"key":"B4","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1002\/ana.20944","article-title":"Dexamethasone and long-term outcome in adults with bacterial meningitis","volume":"60","author":"Weisfelt","year":"2006","journal-title":"Ann Neurol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1517\/14712598.6.11.1193","article-title":"The role of Epstein\u2013Barr virus in cancer","volume":"6","author":"Pattle","year":"2006","journal-title":"Expert Opin Biol Ther"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1212\/CON.0000000000000661","article-title":"Herpesvirus infections of the nervous system","volume":"24","author":"Baldwin","year":"2018","journal-title":"Continuum (Minneap Minn)"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1918613\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:48:43Z","timestamp":1790743723000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1918613\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":6,"alternative-id":["10.3389\/fmed.2026.1918613"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1918613","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"1918613"}}