Disclosures: Mollie E. Andreae, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 22-year-old male with an open skull fracture and severe traumatic brain injury (TBI) presenting with persistent low-grade fever, headache, and lethargy secondary to post-traumatic Nocardia Nova Meningitis.

Case Description: A 22-year-old male was struck by a motor vehicle while biking resulting in an open skull fracture, severe TBI, left hemicraniectomy, and right-sided hemiplegia. In acute inpatient rehabilitation he initially made significant functional gains; however after developing a persistent low-grade fever he began to decline. Infectious work up was negative. Shortly afterwards, he developed abdominal pain and was found to have acute pancreatitis; however, despite appropriate treatment, he remained febrile and began to complain of worsening headaches. Repeat infectious workups continued to be negative. Neuroimaging revealed hydrocephalus ex-vacuo for which he was scheduled for ventriculoperitoneal shunt (VPS) placement by neurosurgery. Intra-operatively, he was noted to have cerebrospinal fluid that was milky in appearance, so samples were sent for analysis and VPS placement was deferred. Culture revealed growth of Nocardia Nova species.

Setting: Acute Inpatient Rehabilitation HospitalAssessment/

Results: He then underwent subgaleal washout, was treated with IV antibiotics, and subsequently experienced resolution of his fevers and functional decline. Upon discharge from acute inpatient rehabilitation, he achieved moderate assistance for a majority of his activities of daily living.

Discussion: Fever is not an uncommon occurrence in patients who sustain a TBI. It can present in both the acute and subacute phases of recovery. There are many possible etiologies; infectious and non-infectious. However, of the infectious causes, post-traumatic meningitis is rare and infection with Nocardia Nova species is even more unusual. To our knowledge, this is only the second reported case of Post-Traumatic Nocardia Nova meningitis.

Conclusion: We present a unique case that demonstrates the importance of maintaining a broad differential and completing a thorough work up for all TBI patients who develop a fever during their rehabilitation course.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-curious-cause-of-persistent-low-grade-fever-in-severe-traumatic-brain-injury-patient-a-case-report/