A lumbar puncture showed a cloudy cerebrospinal fluid with 4400 cells, 90% neutrophils, a protein level of 2.4 (normal 0.15–0.5) g/L and a glucose level of 0.33 (normal 2.22–3.9) mmol/L. Gram staining ...

Gram-positive diplococci were noted on the CSF smear and empirical intravenous treatment with vancomycin, ceftriaxone, and dexamethasone was initiated in the emergency room.

Gram-positive diplococci were identified in blood cultures from our patient. Vegetations of the mitral valve were visualized on a transesophageal echocardiogram.

Probable cases had evidence of Gram-positive diplococci on Gram stain of a normally sterile body fluid, but did not have positive cultures.