BACKGROUND
Aseptic meningitis is a relatively common disease but is extremely rarely complicated by a suboccipital abscess. This report describes and discusses a rare case of a patient with culture-negative pleocytosis suggestive of bacterial infection, followed by suboccipital abscess and sepsis.
CASE REPORT
The patient was a 65-year-old woman who developed a throbbing, holocranial headache that was initially interpreted as a tension-type headache. After signs of meningismus later developed, she was diagnosed with aseptic bacterial meningitis based on a cerebrospinal fluid (CSF) cell count of 15 127 cells/µL, primarily granulocytes containing bacteria-like structures. However, blood, urine, and CSF cultures were negative. Using empirical antibiotic therapy, the patient achieved near complete recovery before discharge. More than a month after this episode, the patient developed a suboccipital abscess complicated by sepsis, necessitating repeated surgical interventions and adjustments to antibiotic therapy. Observations from this case are applicable to patients with strong CSF and clinical indicators of bacterial infection despite negative routine cultures, especially when subsequent deep soft-tissue infection or sepsis emerges. Recurrent headaches or neck pain after initial improvement should prompt reassessment for a deep extracranial infectious complication.
CONCLUSIONS
This case suggests that a presentation initially classified as aseptic meningitis may actually be a culture-negative infection and can be followed by deep soft-tissue abscess formation and sepsis. It also demonstrates that the precise pathogen and source of infection may remain unconfirmed but that empirical antibiotic therapy can be beneficial.

Keywords: Meningitis, Aseptic; Abscess; Headache Disorders, Secondary